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Wyniki leczenia przezskórnego ASD u dzieci , Wyniki leczenia przezskórnego ASD u dzieci ,
implikacje leczenia dla dorosłychimplikacje leczenia dla dorosłych
Jacek Białkowski
Silesian Center for Heart Diseases, Zabrze, Poland
Peripheral Interventions Workshop,8, May 2014 , Kraków
ASD types -90% ASD II
The first report - transcatheter ASD closure (King, JAMA 1976)
Mile stone - Amplatzer Occluders (ASO) (Masura, CCI 1997)
70-80 % ASD II can be closed with transcatheter methods (Podnar,CCI 2001)
Method of choice in our center from 1997
TRANSCATHETER ASD CLOSURE
ASD II CLOSURE
oPercuatneous ASD closure - method of choice (according to ESC guideline 2010)
o Indications – RV dilatation (ECHO) or history of cryptogenic stroke
oNitinol mesh devices are prefered for ASD closure
Nitinol wire mesh device (invented by dr Kurt Amplatz) composed of two disc
Opening of ASO
ASD- OWN EXPERIENCE
Percutaneous ASD closure since 1997
Total number of pts (till june. 2013) 1171• Amplatzer 979 (83,6%)
• Figulla 83 (7,8%)
• Chinese 60 (5,1%)
• CardioSEAL (withdrawn 2012) 50
• Helex 2
Transcatheter ASD closure
Contraindications: Contraindications: too big defect, too big defect, too small rims of IAS too small rims of IAS
( <7 mm - aortic can be ( <7 mm - aortic can be deficientdeficient))
Relation of ASD to sorrounding structures
TRANSCATHETER ASD CLOSURE
LOCALIZATION OF THE DEFECT (ACCORDING OWN MATERIAL)
A) Central (56%)
B) Without aortic rim (42%)
C) Posterior (2%)
-Zespół rsR′ w V1- obecny w 90% ASD IIZespół rsR′ w V1- obecny w 90% ASD II
TRANSCATHETER ASD CLOSURE PROCEDURAL STEPS
GA (children), diagnostic catheterization and TEE
Implantation and repeat TEE
Balloon sizing (omitted in 363 pts)
TRANSCATHETER ASD CLOSURE BALLOON CALIBRATION
Generally crucial for choosing device size
Prefered balloon „stop flow” method , BUT
Omitted in 363 pts
with large ASD
central ASD with stable rims
multifenestrated septum
in small children (too long balloons)
„CLOSURE OF ASD WITH AMPLAZTZER SEPTAL
OCCLUDER IN ADULTS” Majunke, Bialkowski , Am J Cardiol 2009
Nr of patients 650 Single / Double ASD 572/78
Nr of pts > 60 y old 153
Results in pts >60y and<60 y similar
Embolization 6 (2 early) Hemopericardium (erosion) 2 LV heart failure 4
TRANSCATHETER ASD II CLOSURE COMPLICATIONS
Data of AHA(Circ. 2011) Own exp.
• embolization 1,1% 0,7%• erosion/tamponade 0,1% 0,1%• A/V blok (pacemaker) 0,3% 0,1%• Thrombus formation 0,7% 0%• TIA 0,2% 0,1%• Arrhythmia 3,8% 1,2%
EROSION OF ARIAL WALL
Possible even after few months in AGA registry 0,1% higher r isk in ASD without Ao rim and using oversized
devices
Follow-up with TTE is mandatory
RISK FOR EROSION WITH ASOA) INTERMITTENT CONTACT; B) SPLAYING ; C) PROTRUSION ; D) MOTION
ASD II – RHYTHM DISTURBANCES
New symptomatic tachyarrythmias usually sporadically during 3 months after the procedure – 9/738 pts (1,3%) – usualy older pts
SVT in 1 pts (farmacologic treatment) AF in 8 pts (electroshock), BUT….
Complete a-v block in 2 pts (15 and 16 y old - 4,3 and 1,5 y after procedure rescpectively ) - pacemaker
•Szkutnik, Bialkowski et al. „Symptomatic tachy and bradyarrhytmias after transcatheter closure of ASD with Amplatzer
devices”. Cardiol J 2008
Holter ECG intermittent III deg a-v block with pauses up to 7 sec
C O N C L U S I O N Transcatheter ASD closure is effective and
safe method, when performed by experienced interventionalist. Severe complications are rare and long – term results exelent.
Close follow-up of this pts is mandatory
Excellent cooperation with echocardio-graphist is obligatory
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