Page 24 - Journal of Structural Heart Disease Volume 3, Issue 1

17
Original Scienti c Article
Video 1. The occluder was malaligned with the defect. View sup- plemental video at http://dx.doi.org/10.12945/j.jshd.2016.005.16. vid.01.
Video 2. The balloon was partially in ated in the defect. View supplemental video at http://dx.doi.org/10.12945/j. jshd.2016.005.16.vid.02.
ic IAS. In the catheterization laboratory, the occluder failed to align properly with the defect, causing the left disc to be easily pulled through the ASD in re- peated attempts of deployment (Video 1), including clockwise rotation of the sheath to allow initial de- ployment of the left atrial disc in the vicinity of the right upper pulmonary vein. To stabilize the device, a balloon was inserted through an additional femoral venous sheath and partially in ated in the left atri- um (LA; Video 2). The left disc was then deployed and held in the LA by the balloon. While the left disc was anchored in the LA, the right disc was pulled and un- covered in the right atrium (RA) and then advanced toward the IAS, engaging it appropriately (Video 3).
Video 3. The left disc is deployed and held in the left atrium by the balloon. The right disc was uncovered in the right atrium, engaging the interatrial septum. View supplemental video at http://dx.doi.org/10.12945/j.jshd.2016.005.16.vid.03.
Video 4. Balloon de ation and retrieval while the left disc en- gaged the left aspect of the interatrial septum. View supplemen- tal video at http://dx.doi.org/10.12945/j.jshd.2016.005.16.vid.04.
The balloon was de ated and carefully retrieved, al- lowing the left disc to approach the septum (Video 4). The guidewire was also slowly pulled back. The de- vice remained in a suitable position following its re- lease (Video 5).
The balloon-assisted technique can assist in the proper positioning of devices in di cult ASDs [7, 8]. In one case series, balloon-assisted device closure of large (≥35 mm) ASDs had a 90% success rate [9]. The balloon-assisted technique facilitates controlled de- livery and device alignment in very large ASDs and is often helpful when conventional delivery fails.
Tal, R. et al.
Atrial Septal Defect Occlusion Challenges