Related Experiment Video
Updated: Aug 15, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Headache after transcatheter closure of atrial septal defect: An attempt to explain its origin in the pediatric
Sebastian Smerdziński1,2, Michał Gałeczka3, Filip Tyc3,4
1Department of Congenital Heart Defects and Pediatric Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland. smerdzinski@gmail.com.
Insights
Transient headache episodes (THE) after transcatheter atrial septal defect (ASD) closure are linked to balloon calibration and lack of nickel protection. These findings help identify patients at higher risk for post-procedural headaches.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Transcatheter closure is the preferred treatment for atrial septal defects (ASD).
- Transient headache episodes (THE) affect approximately 5% of patients post-procedure, with unclear causes.
Purpose of the Study:
- To identify risk factors for transient headache episodes (THE) in pediatric patients following transcatheter ASD closure.
Main Methods:
- Retrospective analysis of 840 pediatric patients undergoing transcatheter ASD closure with nitinol devices.
- Logistic regression analysis to assess risk factors including age, weight, ASD diameter, device size, nitinol coating, fluoroscopy time, balloon calibration, device oversizing, and residual shunt.
Main Results:
- 4.8% of patients experienced THE.
- Higher incidence of THE associated with balloon calibration (82.5% vs. 43.3%), larger device/balloon sizes, and increased residual shunt.
- Predictors of THE included age, balloon calibration, lack of nickel protection, fluoroscopy duration, and device oversizing.
Conclusions:
- Balloon calibration during percutaneous ASD closure is a significant risk factor for early post-procedural headaches.
- The absence of a protective layer against nickel release on nitinol devices is also linked to headache occurrence.
Background:
Transcatheter closure of atrial septal defect (ASD) has become the treatment of choice for most patients. About 5% of them suffer from transient headache episodes (THE) after the procedure, whose etiology is unclear.
Aims:
To evaluate risk factors for THE occurrence after transcatheter closure of ASD in the pediatric population.
Methods:
Eight hundred and forty patients, after transcatheter ASD closure with nitinol devices, from a single center, were included in retrospective analysis. THE was defined as occurring up to 24 hours after the procedure. A logistic regression model including age, weight, ASD diameter, device size, presence of nitinol coating on the device, fluoroscopy time, application of balloon calibration, device oversizing, and residual shunt after 24 hours was created to evaluate risk factors for THE occurrence.
Results:
There were 40 patients with THE (4.8%), 70% female and 30% male. The median age was 13 (7.35-16) years. In patients with headache, balloon calibration (BC) was performed more frequently (82.5% vs. 43.3%; P <0.001). The balloon waist median (interquartile range [IQR]), 19 (16-22) mm vs. 15 mm (12-18) mm (P <0.001), and device size median (IQR), 18 (13.5-22) mm vs. 14 (11-17) mm (P <0.001) were larger, and residual shunt after 24 hours (12.5% vs. 4.9%; P = 0.03) and a year (7.5 vs. 1.0%; P <0.001) were more frequent. ASD size and the prevalence of double/multiple ASD were similar in both groups. Age, BC application, no nickel release protection, duration of fluoroscopy, and device oversizing were predictors of THE (P <0.001).
Conclusions:
BC during percutaneous ASD closure and the lack of a protective layer against nickel release on the device are risk factors for headache occurrence in the early postprocedural period.
