Page 27 - Journal of Structural Heart Disease Volume 3, Issue 1

Original Scienti c Article
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Video 13. Deploying the entire device in the left atrium allowed the device to return to its original shape. View supplemental vid- eo at http://dx.doi.org/10.12945/j.jshd.2016.005.16.vid.13.
Video 14. Deploying the entire device in the left atrium allowed the device to return to its original shape. View supplemental vid- eo at http://dx.doi.org/10.12945/j.jshd.2016.005.16.vid.14.
Video 15. Normal deployment and release of the device was pos- sible. View supplemental video at http://dx.doi.org/10.12945/j. jshd.2016.005.16.vid.15.
and quickly redeploying the distal disc [12], repeat- ing the procedure several times [13], and loading the device into the sheath while making back-and forth movements in the sheath [14]. Such attempts were at least partially e ective in regaining normal device con guration. In our case, using the Occlu- tech device, we deployed the entire device in the LA (Video 13), allowing it to assume its original shape (Video 14). It was then possible to retrieve the right atrial disc and redeploy the device in the appropriate site with a normal con guration (Video 15). This tech- nique may be e ectively applied for all devices with “cobra”-like formations [15]. With the development of new technologies, however, this obstacle is less fre- quently encountered.
De cient Aortic Rim
De cient aortic rim is a rather common morpho- logic feature of ASD and is present in up to 30–50% of ASDs that are considered complex [16]. De cient aortic rim is a risk factor for aortic erosion after device closure of ASDs. De cient aortic rim has been asso- ciated with increased risk of device impingement on the aorta, but we observed no association between device impingement and the development of aortic insu ciency (Video 16). Ostermayer et al. found that small aortic rim is independently associated with procedural failure [17]. On the other hand, O'Byrne et al. found that de cient aortic rim is highly preva- lent but does not seem to increase the risk of adverse outcomes [18]. Another group found that procedur- al failure mainly occurs with extremely large defects (≥40 mm), regardless of whether an aortic rim of sep- tal tissue was present [19].
Absent aortic rim is not a contraindication for transcatheter closure attempt, but it may result in a more complex procedure and require maneuvers for successful deployment of the device. It is also import- ant to consider whether to minimize the size of the device so that its edges/discs approach the aortic root or whether to select a slightly larger device that would embrace the aortic root to minimize the risk of aortic root erosion. These cases should be thoroughly investigated by TEE to demonstrate the extent of the aortic rim de ciency from several aspects, including 3-dimensional TEE. Adverse e ects following an inter-
Journal of Structural Heart Disease, February 2017
Volume 3, Issue 1:15-27