ABSTRACT
OBJECTIVE: This study reports the procedural, short and medium term outcomes in patients receiving multiple implants for device closure of secundum atrial septal defects (ASD). DESIGN AND SETTING: From the database of the Toronto Congenital Cardiac Centre, 36 consecutive patients (mean age 46+/-15 years; 23 females) received >1 implant for closure of an interatrial communication. Short term (mean 97+/-77 days) and medium term (mean 2.5+/-1.4 years) follow-up data were analyzed. Procedures were performed under intracardiac echo (ICE) and fluoroscopic guidance. RESULTS: The Amplatzer Septal Occluder (ASO) was implanted in all except one. Thirty-one patients had 2, and 4 patients, 3 ASO devices. There were no major adverse events at implantation or on follow-up. Patients with >NYHA class I symptoms fell from 44% to 6% (p<0.05) at 3 months. Right ventricular (RV) systolic pressure fell from 39+/-7 to 32+/-4 mm Hg in the short term (p<0.05), and to 30+/-4 mm Hg in the medium term (p<0.05, compared to baseline) and RV diameters fell from 48+/-5 to 40+/-5 (p<0.05) in the short term and to 38+/-8 mm (p=ns) in the medium term. Small residual leaks were present in 22% at 3 months and 12% (p<0.05) at 1 year. CONCLUSION: Multiple ASD device implants can be safely employed with excellent outcomes. Significant reductions in RV pressure and diameter occur in the short term with a continued trend to benefit.
Subject(s)
Cardiac Catheterization/instrumentation , Cardiac Catheterization/methods , Heart Septal Defects, Atrial/surgery , Prostheses and Implants , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , Adult , Female , Follow-Up Studies , Heart Septal Defects, Atrial/diagnostic imaging , Humans , Male , Middle Aged , Radiography , Treatment OutcomeABSTRACT
A patent foramen ovale (PFO) is a common structural cardiac variant occurring in approximately 30% of the general population. Patients are usually asymptomatic because the defect is flap-like and does not permit significant left-to-right shunting. However, pathological conditions that result in cardiac rotation or higher than normal right atrial pressures can reverse the normal left atrial to right atrial pressure gradient and cause a right-to-left shunt through a PFO. If the right-to-left shunt is persistent, systemic hypoxemia or paradoxical emboli may result. The present report describes a case of refractory hypoxemia in a critically ill patient with a PFO who had a right-to-left shunt with normal right-sided cardiac pressures.
