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Cardiac perforation after device closure of atrial septal defects with the Amplatzer septal occluder
Abhay Divekar1, Tidimogo Gaamangwe, Nasir Shaikh
1Section of Pediatric Cardiology, Health Sciences Center, Winnipeg, Manitoba, Canada. adivekar@exchange.hsc.mc.ca
Insights
Amplatzer septal occluder (ASO) can cause cardiac perforation (CP), a rare complication after atrial septal defect (ASD) closure. This complication often involves the anterosuperior atrial walls and adjacent aorta, with late presentations occurring years after the procedure.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Cardiac perforation (CP) is a rare but serious complication following transcatheter atrial septal defect (ASD) closure.
- The Amplatzer septal occluder (ASO) is a commonly used device for ASD closure.
Purpose of the Study:
- To review and identify cases of ASO-associated cardiac perforation (CP).
- To analyze the characteristics and timing of CP after transcatheter ASD closure.
Main Methods:
- Retrospective review of institutional cases and analysis of cardiac events (CE) from literature and regulatory agencies.
- CEs were defined as definite CP, hemopericardium, pericardial effusion, cardiovascular collapse, or sudden death.
- Events were categorized as early (pre-discharge) or late (post-discharge).
Main Results:
- Twenty-nine cardiac events (CEs) were identified, with 5 excluded due to inconclusive findings.
- Late CEs occurred in 66.6% of cases, with some presenting up to three years post-procedure.
- Cardiac perforation predominantly involved the anterosuperior atrial walls and adjacent aorta; three deaths were reported.
Conclusions:
- ASO-associated CP characteristically affects the anterosuperior atrial walls and adjacent aorta.
- The underlying pathophysiology of ASO-associated CP remains poorly understood.
Objectives:
Amplatzer septal occluder (ASO)-associated cardiac perforation (CP) at our institution prompted this retrospective review.
Background:
Cardiac perforation is a rare complication after transcatheter atrial septal defect (ASD) closure.
Methods:
To identify CP after transcatheter ASD closure with ASO, cardiac events (CE) describing definite CP, hemopericardium, pericardial effusion, cardiovascular collapse, or sudden death were analyzed. Cardiac events were identified from published literature (MEDLINE), medical device regulating agencies in North America and the European Commission, and AGA Medical Corporation (Golden Valley, Minnesota). Institutional cases were reviewed. Cardiac events were defined as early (pre-discharge) or late (post-discharge).
Results:
Twenty-nine CEs were identified. Five were excluded because findings were inconclusive for device-related CP. Ten patients were <18 years of age. Late CEs occurred in 66.6%; 25% presented weeks later (longest, three years). Three deaths were reported. Cardiac perforation occurred predominantly in the anterosuperior atrial walls and/or adjacent aorta.
Conclusions:
Amplatzer septal occluder-associated CP uniquely involves the anterosuperior atrial walls and adjacent aorta. Pathophysiology remains poorly understood.
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