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• CardioSEAL (withdrawn 2012) 50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