Transcatheter closure of atrial septal defects using the Cardio-Seal implant
C A Pedra1, J Pihkala, K J Lee
1Department of Pediatrics, Division of Cardiology, The Variety Club Catheterization Laboratories, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
Insights
Transcatheter closure of atrial septal defects using the Cardio-Seal implant effectively corrects heart volume overload with good early outcomes. This minimally invasive procedure shows promise for improving cardiac function in pediatric patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Atrial septal defects (ASDs) can lead to right ventricular volume overload and subsequent hemodynamic disturbances.
- Transcatheter closure offers a less invasive alternative to surgical repair for ASDs.
Observation:
- The Cardio-Seal device was used for transcatheter closure in 50 pediatric patients.
- Procedures were performed under general anesthesia with transesophageal guidance.
- Challenges included multiple ASDs and deficient atrial rims in a significant proportion of patients.
Findings:
- The Cardio-Seal implant demonstrated successful deployment in most cases with no immediate complications.
- Post-procedure, right ventricular dimensions normalized, and septal motion abnormalities resolved.
- While a small residual shunt was observed in some patients, no adverse effects were noted from device-related findings like arm fractures or protrusion.
Implications:
- Transcatheter closure with the Cardio-Seal device effectively addresses hemodynamic issues in ASD patients.
- The procedure offers a favorable early outcome, correcting right ventricular volume overload.
- Further research may explore predictors for residual shunts and long-term device performance.
Objective:
To review the outcomes of transcatheter closure of atrial septal defects using the Cardio-Seal implant.
Design:
A prospective interventional study.
Setting:
Tertiary referral centre.
Patients:
The first 50 patients (median age 9.7 years) who underwent attempted percutaneous occlusion.
Interventions:
Procedures were done under general anaesthesia and transoesophageal guidance between December 1996 and July 1998.
Main Outcome Measures:
Success of deployment, complications, and assessment of right ventricular end diastolic diameter, septal wall motion, and occlusion status by echocardiography.
Results:
The median balloon stretched diameter was 14 mm. Multiple atrial septal defects were present in 11 patients (22%) and a deficient atrial rim (< 4 mm) in 19 (38%). In four patients (8%), a second device was implanted after removal of an initially malpositioned first implant. There were no significant immediate complications. All patients except one were discharged within 24 hours. At the latest follow up (mean 9.9 months) a small shunt was present in 23 patients (46%), although right ventricular end diastolic dimensions (mean (SD)) corrected for age decreased from 137 (29)% to 105 (17)% of normal, and septal motion abnormalities normalised in all but one patient. No predictors for a residual shunt were identified. Supporting arm fractures were detected in seven patients (14%) and protrusion of one arm through the defect in 16 (32%), the latter being more common in those with smaller anterosuperior rims. No untoward effects resulted from arm fractures or protrusion. There were no complications during follow up, although five patients (10%) experienced transient headaches.
Conclusions:
The implantation of the Cardio-Seal device corrects the haemodynamic disturbances secondary to the right ventricular volume overload, with good early outcome.
