Percutaneous closure of atrial septal defect 3

Presented by: Dr. Ibdah

65 year old patient ,female c/o : SOB, occasional palpitations TEE: ASD II , Left to Right Shunt. Diameter

of defect 14 mm . RV dilated with signs of volume overloading

Right heart Catheterization: PA sys 36mmHg

PVR 61 dyn/cm5 Balloon sizing :

successful transcatheter ASD closure with Amplazer device 22mm

Common 3-10% of CHD Classification: ASD I, ASD II 70%, sinus

venosus Female > Male Pathophsiology : initially left to right shunt Clinical features and diagnostic evaluation: are not the scope of this presentation!

Three questions crystallize the debate :

1.Who should have their ASD closed?2.When should it be closed? 3.How should it be closed?

Any patient with dilated RV or RA by Echo,MRT or CT

any ASD ( in the absence of of advanced pulmonary HTN) with one or more of following:

1.ASD > 10 mm on TEE2.Qp:Qs > 1.5:1

Yes close it and yes do it as soon as possible !

Is the age matter ? The answer is NO

The defect too small follow them periodically

Severe pulmonary arterial HTN ; do not close ! ASD acts here as ``pop-off`` valve

Pregnancy defer 6 months after delivery Severe LV dysfunction . Again ASD

functioning as`` pop-off`` valve

Device closure is a safe and effective procedure in experienced hands

Advantages of device closure : less hospital stay, avoidance surgical wounds,

same hemodynamic benefit as by surgery Drawbacks: large defect > 36 mm, septal rim less

than 5 mm, proximity of defect to AV ,CS,IVC,SVC

Successful closure achieved in 95 % of Pt. Tachyarrhythmia 1-4% follow up , ablation Brady arrhythmia Pacing Device migration and erosion : catastrophic but

rare 0,1 %related to operator experience and over sizing

Right heart failure or progressive pulmonary HTN ; related to the age of patient at the time of closure

Thrombosis 1.2 %: maximal at 4 weeks ,rare with dual therapy era

Nickel allergy ! Chest pain at next day do skin test if positive remove the device

Small: common after catheter closure ,close spontaneously after 1 year

Large : false measurement, dehisced ASD device

Dual antiplatelet therapy 6 months TTE next day . TEE in 1,6 and in 12 months IE-prophylaxis for 6 months

Majority of ASD II are device closable Safe and effective procedure need for excellent pre-procedure work up

Thank you for your attention