Page 13 - Journal of Structural Heart Disease Volume 4, Issue 3

Original Scienti c Article
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atrial septal anatomy (cardiac chamber size, defect size and position, septal thickness, presence of extra structure close to the defect, etc.) [6, 7]. In rare cases, device-related factors (Cobra like deformity during deployment) and delivery system deformity (kinking or distortion) is the reason behind procedure prolon- gation. These causes of prolongation may happen separately or in combination. Such unexpected situ- ations might increase the uoroscopy time, radiation dose, risk of complications and procedural failure.
Though some factors leading to procedure prolon- gation have been reported sporadically [8], our aim was to nd the patient demographic, cardiac ana- tomical and device-related factors that could foresee procedure prolongation. Additionally, we report pro- cedure failure and complications.
Methods and Patients
In a retrospective, cohort study, all children < 18 years (n = 89) who were referred for PTCC of their ASD between October 2010 and October 2015 were in- cluded in this study.
Under general anesthesia, patients were intu- bated, a trans-esophageal-echocardiography (TEE) (Philips Medical Systems, iE33, Andover, MA, USA), was performed by one of the two experienced pedi- atric cardiologists (MES, MOG) before starting cathe- terization. The ASD and the atrial septum were eval- uated in terms of defect size, number and position, total septal length, measurement of all rims around the defect, and the relation of the defect to the ad- jacent structures, including the venae cavae, atrio- ventricular valves, pulmonary veins and the coronary sinus. In particular, measurement of rims toward the atrioventricular valve (AV), pulmonary veins, ascend- ing aorta and the rims toward inferior and superior vena cavae were performed [9-10]. The patient was sent for surgical closure if the ASD was too large that the occluder device which will be used will a ect the adjacent structures, if there are more than two de - cient rims (< 5 mm) [1], if the rim was de cient and imsy toward the inferior vena cava or if the patient had other associated cardiac lesions.
In our practice, the size of the occluder device (Am- platzer Septal Occluder [ASO] or Occlutech) was se- lected by adding 1 to 2 mm to color Doppler size of
the ASD [8, 11]. No balloon sizing of the defect was performed. At the beginning of the study period, the choice of the closure device (ASO; AGA Medical Cor- poration, Golden Valley, MN, USA, or Occlutech, Flex II, Helsingborg, Sweden) was based on availability and patient age and size. However, during the study period, we did not continue with this selection crite- ria and device type selection depended on availabili- ty and operator preference.
All procedures were performed by two experi- enced interventional paediatric cardiologists (MES, MOG). After right heart catheterization and con r- mation of normal pulmonary artery pressure, the occluder device was deployed through the delivery sheath of recommended size under uoroscopy and real-time TEE. The device was released after careful con rmation of good positioning and presence of septal tissue between the device discs followed by a gentle Minnesota wiggling [12, 13]. Additionally, we made sure that the device was neither distorting the ascending aortic con guration nor impinging on the venae cavae and pulmonary veins, and that it was not a ecting the atrioventricular valve function. Within 24 hours after catheterization, all patients underwent repeattransthoracicechocardiography,chestradiog- raphy, and electrocardiography (ECG).
The Institutional Review Board at King Fahad Med- ical City, Riyadh approved this study (IRB Log No. 15- 408). Informed consent was waived based on the ret- rospective study design.
Data collection
Medical charts, echocardiographic recordings per- formed before, during and after the procedure, cath- eterization reports and recorded uoroscopic lms of all patients were reviewed. Demographic data (age, sex, weight, height and body surface area) were col- lected.
Echocardiographic parameters
In the pre-procedural Transthoracic Echocardiog-
raphy (TTE) the defect size, number of defects (sin- gle versus multiple) and position, total septal length, measurement of the rims around the defect (rims to- ward the atrioventricular (AV) valves, ascending aorta, pulmonary veins, and venae cavae) were estimated.
Journal of Structural Heart Disease, June 2018
Volume 4, Issue 3:69-78