Non-surgical Closure of Intracardiac and Extracardiac Defects

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US Cardiology 2004;2004:1(1):1-3

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In the last decade, transcatheter closure of various cardiac defects has become a safe and effective alternative to surgery.1 The advantages include less procedure time, shorter hospital stay, less emotional stress, and no scar on the chest. The defects that can be closed non-surgically include intracardiac defects such as the atrial septal defect (ASD), patent foramen ovale (PFO), ventricular septal defect (VSD), etc., and extracardiac defects such as patent ductus arteriosus (PDA) and various abnormal vessels, etc. Different defects require different specially designed devices which are discussed below.

ASD

The secundum type ASD, located at the central portion of the atrial septum, is amenable to non-surgical closure.2 Many devices have been used, including the clamshell, Cardioseal, Starflex, button, Das Angel wings device and ASD occluder system etc., that are accompanied by a certain incidence of residual shunt.2,3 The Amplatzer Septal Occluder is the first and only device to ever receive full approval for clinical use in children and adults with secundum ASD from the US Food and Drug Administration (FDA). It is a self-expanding, double-disk device made from nitinol wires with Dacron polyester patches sewn into each disc and the connecting waist, to increase the thrombogenicity of the device. The mechanism of closure involves stenting of the ASD by the waist of the device and subsequent thrombus formation within the device with eventual complete neoendothelialization. The initial human use was reported in 1997 with correct placement in all 30 patients studied with a 100% complete closure rate in 25 patients completing the three-month follow-up.2 So far, the closure rate is greater than 98% and the implantation rate is exceptional at 95.6%.3 Because it is safe, user-friendly and effective, the ASO is poised to be the procedure of choice for secundum ASD closure by both patients and cardiologists.3

PFO

PFO has been recognized increasingly as a source of paradoxical embolism causing transient ischemic attack, stroke or migraine.3,4 It can be closed by various ASD devices with good results. The Amplatzer PFO occluder is similar in construction to the ASO. The right atrial disc is larger than the left atrial disc and measures 18, 25 or 35mm.4 There is a short 3mm waist segment. The initial results have been very encouraging with 100% successful placement and 100% complete occlusion.3

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References
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