際際滷

際際滷Share a Scribd company logo

Percutaneous closure of atrial septal defect 3

Download as PPT, PDF
Rasheed Ibdah
Rasheed Ibdah

This document summarizes a presentation on transcatheter closure of an atrial septal defect (ASD). A 65-year-old female patient presented with shortness of breath and occasional palpitations. Testing revealed a 14mm ASD with left-to-right shunting and right ventricular dilation. The patient underwent a successful transcatheter closure of the ASD using an 22mm Amplatzer device. The presentation covered recommendations for when closure is indicated based on defect size and shunt ratio, advantages of device closure over surgery, potential complications, and follow-up care after the procedure.

1 of 16
Downloaded 101 times
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 :
Percutaneous closure of atrial septal defect 3
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 TEE 2. 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
Percutaneous closure of atrial septal defect 3
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

More Related Content

Percutaneous closure of atrial septal defect 3

  • 2. 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 :
  • 4. successful transcatheter ASD closure with Amplazer device 22mm
  • 5. 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!
  • 6. Three questions crystallize the debate : 1. Who should have their ASD closed? 2. When should it be closed? 3. How should it be closed?
  • 7. 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 TEE 2. Qp:Qs > 1.5:1
  • 8. Yes close it and yes do it as soon as possible ! Is the age matter ? The answer is NO
  • 9. 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
  • 11. 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
  • 12. 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
  • 13. Small: common after catheter closure ,close spontaneously after 1 year Large : false measurement, dehisced ASD device
  • 14. Dual antiplatelet therapy 6 months TTE next day . TEE in 1,6 and in 12 months IE-prophylaxis for 6 months
  • 15. Majority of ASD II are device closable Safe and effective procedure need for excellent pre-procedure work up
  • 16. Thank you for your attention