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Cardiology
Percutaneous Closure of Atrial Septal Defect and Patent Foramen Ovale
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 95 slides
Overview
- Scope of this topic
Atrial septal defect
- Origins of transcatheter ASD closure
- Formation of the interatrial septum
- Septation sequence of the fetal atria
- Fate of the foramen ovale after birth
- Anatomical classification of atrial septal defects
- Types of atrial septal defect
- Anomalies associated with atrial septal defects
- Ostium primum defect as a surgical lesion
- Haemodynamic consequences of an atrial septal defect
- Endocarditis prophylaxis in atrial septal defect
- Indications for percutaneous ASD closure
- Small defects without significant shunting
- Closure decision in atrial septal defect
- Fixed pulmonary hypertension and Eisenmenger physiology
- Large defects with prolonged left-to-right shunting
Devices and closure technique
- Amplatzer septal occluder construction
- Amplatzer septal occluder sizing and delivery
- Amplatzer septal occluder
- Amplatzer Cribriform occluder
- Cribriform occluder for a fenestrated septum
- Occlutech ASD occluder
- Occlutech ASD occluder
- Gore Cardioform septal occluder
- Gore Cardioform septal occluder
Performing the closure
- Pre-procedural transoesophageal echocardiography
- Deficient inferior rim
- Anaesthesia and imaging guidance strategies
- Access and anticoagulation
- Exchange for a stiff wire
- Balloon sizing of the defect
- Balloon sizing of the atrial septal defect
- Device selection and oversizing
- Sheath introduction and air embolism prevention
- Confirming device attachment before advancing
- Deployment sequence of the double-disc device
- Deployment sequence
- Disc deployment on echocardiography and fluoroscopy
- Closure with the Gore device
- Post-procedural care and follow-up after ASD closure
- Expected and late events after ASD closure
Pitfalls and special situations
- Balloon instability during sizing
- Enlargement of the defect during the procedure
- Device embolization
- Snaring an embolized occluder in the pulmonary artery
- Residual leak and device thrombus after ASD closure
- Sinus venosus defects and atrial fibrillation
- Iatrogenic atrial septal defect
- Selective closure of iatrogenic defects
Patent foramen ovale
- Anatomy of the patent foramen ovale
- Consequences of right-to-left shunting through a PFO
- Paradoxical embolism through a patent foramen ovale
- Conditions associated with patent foramen ovale
- Anatomical categories of patent foramen ovale
- Semi-quantitative grading of PFO shunt severity
- Indications for PFO closure
- Randomised trials of PFO closure for stroke prevention
- Results of the randomised PFO closure trials
- Establishing a diagnosis of PFO-related stroke
- Risk scores for attributing stroke to the PFO
- PFO closure for primary prevention
- Migraine and patent foramen ovale
- Randomised evidence for PFO closure in migraine
- Selecting migraine patients for closure
- Further potential considerations for PFO closure
PFO devices and technique
- Devices approved for PFO closure
- Gore Cardioform occluder for PFO closure
- Choosing between the two PFO devices
- Amplatzer PFO occluder
- Anaesthesia and imaging for PFO closure
- Opening steps of PFO closure
- Deploying the Amplatzer Talisman device
- Deploying the Gore Cardioform device for PFO
- Gore Cardioform closure sequence
- Criteria for stable device position before release
- Pacman sign of correct device seating
- Post-procedural care after PFO closure
- Difficult sheath advancement through the groin
- Absent back-bleeding after wire removal
- Residual leak on follow-up after PFO closure
- Device thrombus on follow-up after PFO closure
- Summary of ASD closure
- Summary of PFO closure
- References
- References
- References
- References
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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