Chapter 32
Management of Iatrogenic Interatrial Septal Defect—To Close or not to Close?
Christina Tan,
James M. McCabe,
Christina Tan
Division of Cardiology, Kaiser Permanente, Honolulu, HI, USA
Search for more papers by this authorJames M. McCabe
Division of Cardiology, University of Washington, Seattle, WA, USA
Search for more papers by this authorChristina Tan,
James M. McCabe,
Christina Tan
Division of Cardiology, Kaiser Permanente, Honolulu, HI, USA
Search for more papers by this authorJames M. McCabe
Division of Cardiology, University of Washington, Seattle, WA, USA
Search for more papers by this authorBook Editor(s):Ron Waksman,
Toby Rogers,
Ron Waksman
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
Search for more papers by this authorToby Rogers
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
Search for more papers by this authorFirst published: 12 March 2021
Summary
Many transcatheter mitral valve replacements (TMVRs) are performed via percutaneous venous access and require crossing of the intraatrial septum, which creates an iatrogenic atrial septal defect (iASD). This chapter summarizes the relevant hemodynamic principles and known literature regarding persistence and management of iASDs. The echocardiographic evaluation of ASDs by TTE has been previously well-described in the congenital literature. Multiple hemodynamic principles need to be considered relative to iASDs, specifically atrial compliance, ventricular diastolic function, and pulmonary hypertension. Several devices are current approved for closure of atrial septal defects. These include the Amplatzer Septal Occluder, CardioSEAL/STARFlex Septal Occluder, GORE CARDIOFORM Septal Occluder, and ButtonSeal Centering on Demand devices.
References
- Hasenfuß, G., Hayward, C., Burkhoff, D. et al. (2016). A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction (REDUCE LAP-HF): a multicentre, open-label, single-arm, phase 1 trial. Lancet 387 (10025): 1298–1304. https://doi.org/10.1016/S0140-6736(16)00704-2.
- Feldman, T., Mauri, L., Kahwash, R. et al. (2018). Transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction (REDUCE LAP-HF I [reduce elevated left atrial pressure in patients with heart failure]). Circulation 137 (4): 364. LP-375. http://circ.ahajournals.org/content/137/4/364.abstract.
- Cequier, A., Bonan, R., Serra, A. et al. (1990). Left-to-right atrial shunting after percutaneous mitral valvuloplasty. Circulation 81 (4): 1190–1197. https://doi.org/10.1161/01.cir.81.4.1190.
- Mcginty, P.M., Smith, T.W., and Rogers, J.H. (2011). Transseptal left heart catheterization and the incidence of persistent iatrogenic atrial septal defects. J. Interv. Cardiol. 24 (3): 254–263. https://doi.org/10.1111/j.1540-8183.2011.00630.x.
- Singh, S.M., Douglas, P.S., and Reddy, V.Y. (2011). The incidence and long-term clinical outcome of iatrogenic atrial septal defects secondary to transseptal catheterization with a 12F transseptal sheath. Circ. Arrhythm. Electrophysiol. 4 (2): 166–171. https://doi.org/10.1161/CIRCEP.110.959015.
- Sur, J.P., Pagani, F.D., and Moscucci, M. (2009). Percutaneous closure of an iatrogenic atrial septal defect. Catheter. Cardiovasc. Interv. 73 (2): 267–271. https://doi.org/10.1002/ccd.21768.
- Srinivas, C.V., Collins, N., Borger, M.A. et al. (2007). Hypoxemia complicating LVAD insertion: novel application of the Amplatzer PFO occlusion device. J. Card. Surg. 22 (2): 156–158. https://doi.org/10.1111/j.1540-8191.2007.00370.x.
- Kapur, N.K., Conte, J.V., and Resar, J.R. (2007). Percutaneous closure of patent foramen ovale for refractory hypoxemia after HeartMate II left ventricular assist device placement. J. Invasive Cardiol. 19 (9): E268–E270.
-
Kavarana, M.N., Rahman, F.A., Recto, M.R., and Dowling, R.D. (2005). Transcatheter closure of patent foramen ovale after left ventricular assist device implantation: intraoperative decision making. J. Heart Lung Transplant.
24 (9): 5–6. https://doi.org/10.1016/j.healun.2005.02.007.
10.1016/j.healun.2005.02.007 Google Scholar
- Schueler, R., Öztürk, C., Wedekind, J.A. et al. (2015). Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution. JACC Cardiovasc. Interv. 8 (3): 450–459. https://doi.org/10.1016/j.jcin.2014.10.024.
- Sirker, A., Hyde, J., and Hildick-Smith, D. (2006). Refractory hypoxemia after mitral valve surgery: an unusual cause and its successful percutaneous treatment. J Invasive Cardiol 18 (2): E86–E88.
- Huntgeburth, M., Müller-Ehmsen, J., Baldus, S., and Rudolph, V. (2013). Postinterventional iatrogenic atrial septal defect with hemodynamically relevant left-to-right and right-to-left shunt as a complication of successful percutaneous mitral valve repair with the MitraClip. Int. J. Cardiol. 168 (1): e3–e5. https://doi.org/10.1016/j.ijcard.2013.05.018.
- Vasquez, A.F. and Lasala, J.M. (2013). Atrial septal defect closure. Cardiol. Clin. 31 (3): 385–400. https://doi.org/10.1016/j.ccl.2013.05.003.
- Saitoh, T., Izumo, M., Furugen, A. et al. (2012). Echocardiographic evaluation of iatrogenic atrial septal defect after catheter-based mitral valve clip insertion. Am. J. Cardiol. 109 (12): 1787–1791. https://doi.org/10.1016/j.amjcard.2012.02.023.
- Hoffmann, R., Altiok, E., Reith, S. et al. (2014). Functional effect of new atrial septal defect after percutaneous mitral valve repair using the MitraClip device. Am. J. Cardiol. 113 (7): 1228–1233. https://doi.org/10.1016/j.amjcard.2013.12.035.
- Jones, T.K., Latson, L.A., Zahn, E. et al. (2007). Results of the U.S. multicenter pivotal study of the HELEX Septal Occluder for percutaneous closure of Secundum atrial Septal defects. J. Am. Coll. Cardiol. 49 (22): 2215–2221. https://doi.org/10.1016/j.jacc.2006.11.053.
- Søndergaard, L., Kasner, S.E., Rhodes, J.F. et al. (2017). Patent foramen Ovale closure or antiplatelet therapy for cryptogenic stroke. N. Engl. J. Med. 377 (11): 1033–1042. https://doi.org/10.1056/NEJMoa1707404.
- Ibrahim N. FDA Approval Letter. https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm604786.htm.
- Saver, J.L., Carroll, J.D., Thaler, D.E. et al. (2017). Long-term outcomes of patent foramen Ovale closure or medical therapy after stroke. N. Engl. J. Med. 377 (11): 1022–1032. https://doi.org/10.1056/NEJMoa1610057.
- Everett, A.D., Jennings, J., Sibinga, E. et al. (2009). Community use of the Amplatzer atrial septal defect occluder: results of the multicenter MAGIC atrial septal defect study. Pediatr. Cardiol. 30 (3): 240–247. https://doi.org/10.1007/s00246-008-9325-x.
-
Masura, J., Gavora, P., Formanek, A., and Hijazi, Z.M. (1997). Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder: initial human experience. Cathet. Cardiovasc. Diagn.
42 (4): 388–393. https://doi.org/10.1002/(SICI)1097-0304(199712)42:4<388::AID-CCD7>3.0.CO;2-7.
10.1002/(SICI)1097-0304(199712)42:4<388::AID-CCD7>3.0.CO;2-7 CAS PubMed Web of Science® Google Scholar
- Nugent, A.W., Britt, A., Gauvreau, K. et al. (2006). Device closure rates of simple atrial Septal defects optimized by the STARFlex device. J. Am. Coll. Cardiol. 48 (3): 538–544. https://doi.org/10.1016/j.jacc.2006.03.049.
- Syamasundar Rao, P., Berger, F., Rey, C. et al. (2000). Results of transvenous occlusion of secundum atrial septal defects with the fourth generation buttoned device: comparison with first, second and third generation devices. J. Am. Coll. Cardiol. 36 (2): 583–592. https://doi.org/10.1016/S0735-1097(00)00725-7.
- Goy, J.J., Stauffer, J.C., Yusoff, Z. et al. (2006). Percutaneous closure of atrial septal defect type ostium secundum using the new intrasept occluder: initial experience. Catheter. Cardiovasc. Interv. 67 (2): 265–267. https://doi.org/10.1002/ccd.20607.
- Cooke, J.C., Gelman, J.S., and Harper, R.W. (2001). Echocardiologists' role in the deployment of the Amplatzer atrial Septal Occluder device in adults. J. Am. Soc. Echocardiogr. 14 (6): 588–594. https://doi.org/10.1067/mje.2001.113364.
- Boccalandro, F., Baptista, E., Muench, A. et al. (2004). Comparison of intracardiac echocardiography versus transesophageal echocardiography guidance for percutaneous transcatheter closure of atrial septal defect. Am. J. Cardiol. 93 (4): 437–440. https://doi.org/10.1016/j.amjcard.2003.10.037.
- Smith, T., McGinty, P., Bommer, W. et al. (2012). Prevalence and echocardiographic features of iatrogenic atrial septal defect after catheter-based mitral valve repair with the MitraClip system. Catheter. Cardiovasc. Interv. 80 (4): 678–685. https://doi.org/10.1002/ccd.23485.
- Lurz P, Unterhuber M, Rommel KP, et al. Closure of Iatrongenic Atrial Septal Defect Following Transcatheter Mitral Valve Repair: the Randomized MITHRAS Trial. Circulation. 2020; Epub ahead a print. https://doi.org/10.1161/CIRCULATIONAHA.120.051989
