Original Scientific Articles
Journal of Structural Heart Disease, February 2017, Volume 3, Issue 1:15-27
Challenges in Atrial Septal Defect Occlusion
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
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.
Video 1The occluder was malaligned with the defect.
Video 2The balloon was partially inflated in the defect.
Video 3The left disc is deployed and held in the left atrium by the balloon
Video 4Balloon deflation and retrieval while the left disc engaged the left aspect of the interatrial septum.
Video 5The occluder was released and remained in position.
Video 6A 32-mm atrial septal defect with reasonable margins.
Video 7The occluder failed to align appropriately with the interatrial septum.
Video 8The occluder failed to align appropriately with the interatrial septum.
Video 9The dilator was introduced to facilitate deployment.
Video 10The dilator retained the left disc in the left atrium, allowing engagement of the interatrial septum from the right.
Video 11The 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 13Deploying the entire device in the left atrium allowed the device to return to its original shape.
Video 14Deploying the entire device in the left atrium allowed the device to return to its original shape.
Video 15Normal deployment and release of the device was possible.
Video 16Atrial septal defect with deficient aortic rim with an occluder in situ embracing the aortic root.
Video 17The device was malaligned with the septum.
Video 18The left disc was partially deployed in upper left pulmonary vein, allowing proper right disc deployment.
Video 19The device assumed a normal position.
Video 20Secundum atrial septal defect near the superior vena cava opening into the right atrium.
Video 21Contrast injection in the superior vena cava confirmed no obstruction to superior vena cava flow.
Video 22Double interatrial septum.
Video 23Improper deployment of the entire device in the left atrium.
Video 24Improper deployment of the entire device in the left atrium.
Video 25A floating device in the left atrium following its release.
Video 26A floating device in the left atrium following its release.
Video 27Snaring attempts.
Video 28The device was seized and retrieved by biopsy forceps.
Video 29The device was seized and retrieved by biopsy forceps.
Video 30Re-deployment of the device.
Video 31Re-deployment of the device.
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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