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Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter
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Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter

Published on: June 15, 2015

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Cardiac erosion after catheter closure of atrial septal defect: Septal malalignment may be a novel risk factor for

Yasufumi Kijima1, Teiji Akagi2, Koji Nakagawa1

  • 1Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan.

Journal of Cardiology Cases
|December 15, 2018
PubMed

Insights

Cardiac erosion is a serious risk following atrial septal defect (ASD) closure with the Amplatzer Septal Occluder. Atrial septal malalignment may be a newly identified risk factor for this complication.

Area of Science:

  • Cardiology
  • Medical Devices
  • Surgical Complications

Background:

  • Catheter closure of atrial septal defects (ASD) is a common procedure.
  • Cardiac erosion is a rare but severe complication associated with Amplatzer Septal Occluder use.
  • Previous studies identified oversized devices and deficient aortic rims as risk factors.

Purpose of the Study:

  • To investigate the potential role of atrial septal malalignment as a novel risk factor for cardiac erosion after ASD catheter closure.
  • To discuss identified risk factors contributing to cardiac erosion.

Main Methods:

  • Case report detailing pericardial tamponade after Amplatzer Septal Occluder implantation.
  • Pre-procedural echocardiography (2D and 3D transesophageal) to assess anatomical features.
  • Surgical confirmation of cardiac perforation.

Main Results:

  • Pericardial tamponade occurred three days post-procedure.
  • Echocardiography revealed a deficient aortic rim and atrial septal malalignment.
  • Emergent surgery confirmed right atrial perforation into the aortic root.
  • Oversized device deployment and deficient aortic rim are established risk factors.
  • Atrial septal malalignment is proposed as a novel risk factor.

Conclusions:

  • Cardiac erosion is a potentially lethal complication of Amplatzer Septal Occluder use in ASD closure.
  • Atrial septal malalignment may represent a significant, previously unrecognized risk factor.
  • Further research is needed to fully elucidate the mechanisms of cardiac erosion.

Keywords:
Atrial septal defectComplicationErosionPediatric interventions

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