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Journal of Structural Heart Disease, February 2017, Volume 3, Issue 1:15-27
DOI: 10.12945/j.jshd.2016.005.16

Challenges in Atrial Septal Defect Occlusion

Roie Tal1, Moshe Dotan2, Yitzhack Schwartz1, Avraham Lorber1*

1 Pediatric Cardiology and Adults with Congenital Heart Disease Institute, Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
2 Pediatric Cardiology, Ziv Medical Center, Safed, Israel

Abstract

We present 11 cases of percutaneous transcatheter occlusion of atrial septal defects (ASDs) in adults, including multi-fenestrated ASD, balloon-assisted deployment of ASD occlude, dilator-assisted deployment of ASD occlude, "cobra"-shaped disfiguration of the left disc, ASD with deficient aortic rim, pulmonary vein-assisted deployment of ASD occlude, "high" ASD, large Chiari network, double interatrial septum, snaring a runaway occluder, and right ventricular diastolic dysfunction causing cyanosis. Each case is followed by a practical discussion of the special dilemmas, complications, and challenges that may occur during common procedures.

Supplemental Media

  • Video 1

    The occluder was malaligned with the defect.

  • Video 2

    The balloon was partially inflated in the defect.

  • Video 3

    The left disc is deployed and held in the left atrium by the balloon

  • Video 4

    Balloon deflation and retrieval while the left disc engaged the left aspect of the interatrial septum.

  • Video 5

    The occluder was released and remained in position.

  • Video 6

    A 32-mm atrial septal defect with reasonable margins.

  • Video 7

    The occluder failed to align appropriately with the interatrial septum.

  • Video 8

    The occluder failed to align appropriately with the interatrial septum.

  • Video 9

    The dilator was introduced to facilitate deployment.

  • Video 10

    The dilator retained the left disc in the left atrium, allowing engagement of the interatrial septum from the right.

  • Video 11

    The dilator retained the left disc in the left atrium, allowing engagement of the interatrial septum from the right.

  • Video 12

    “Cobra”-shape disfiguration of the left disc.

  • Video 13

    Deploying the entire device in the left atrium allowed the device to return to its original shape.

  • Video 14

    Deploying the entire device in the left atrium allowed the device to return to its original shape.

  • Video 15

    Normal deployment and release of the device was possible.

  • Video 16

    Atrial septal defect with deficient aortic rim with an occluder in situ embracing the aortic root.

  • Video 17

    The device was malaligned with the septum.

  • Video 18

    The left disc was partially deployed in upper left pulmonary vein, allowing proper right disc deployment.

  • Video 19

    The device assumed a normal position.

  • Video 20

    Secundum atrial septal defect near the superior vena cava opening into the right atrium.

  • Video 21

    Contrast injection in the superior vena cava confirmed no obstruction to superior vena cava flow.

  • Video 22

    Double interatrial septum.

  • Video 23

    Improper deployment of the entire device in the left atrium.

  • Video 24

    Improper deployment of the entire device in the left atrium.

  • Video 25

    A floating device in the left atrium following its release.

  • Video 26

    A floating device in the left atrium following its release.

  • Video 27

    Snaring attempts.

  • Video 28

    The device was seized and retrieved by biopsy forceps.

  • Video 29

    The device was seized and retrieved by biopsy forceps.

  • Video 30

    Re-deployment of the device.

  • Video 31

    Re-deployment of the device.

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Cite this article as: Tal R, Dotan M, Schwartz Y, Lorber A. Challenges in Atrial Septal Defect Occlusion. Structural Heart Disease 2017;3(1):15-27. DOI: 10.12945/j.jshd.2016.005.16

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