OBJECTIVETo observe the effect of oversized occluder on endothelialization post percutaneous closure of experimental atrial septal defect (ASD) in dogs.

METHODSASD was established with the help of transthoracic echocardiography in 18 dogs. ASD size was (6.0 ± 0.2) mm. Dogs were randomly divided into normal size group (implanted with 8 mm occlude, n = 9) and oversized group (implanted with 12 mm occluder, n = 9). Dogs were randomly killed at 3, 6 and 14 months after percutaneous closure. The endothelialization process on device surface was observed by scanning electron microscope.

RESULTSFour animals died around 1 month post procedure. Microscopic sections from normal group showed nearly complete endothelialization at 3 months after device implantation and complete endothelialization at 6 and 14 months after device implantation. While microscopic sections showed lack of endothelialization at 3 months post implantation, nearly endothelialization at 6 months, and complete endothelialization at 14 months after device implantation in oversized group.

CONCLUSIONIncomplete endothelialization of occluder surface is observed at 6 months after implantation of an oversized ASD occluder device in this model.

Animals ; Dogs ; Echocardiography ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Percutaneous Coronary Intervention ; Septal Occluder Device

Adolescent ; Cardiac Catheterization ; methods ; Child, Preschool ; Echocardiography, Transesophageal ; methods ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Humans ; Treatment Outcome

Adolescent ; Child ; Child, Preschool ; Echocardiography, Three-Dimensional ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Humans ; Male

BACKGROUNDIn China, transthoracic echocardiography (TTE) is popularly used for pre-intervention examination for atrial septal defect (ASD) and for guiding ASD closure. However, the ability to determine ASD size and the safety and efficacy of TTE for guiding ASD closure still has not been widely accepted. This study aimed to evaluate the efficacy and safety of TTE used before, during and after transcatheter ASD closure with Amplatzer septal occluders (ASO).

METHODSSixty-eight subjects (15 men and 53 women; mean age (33.7 +/- 17.3) years) were enrolled. TTE was used to measure the diameters and guide transcatheter closure of ASD. The ASD was examined by long-axis view, basal short-axis view, apical four-chamber view and the subcostal view to observe position, diameter and relation with neighbouring structures. The largest diameter was selected as the reference diameter. Patients were divided into 3 groups according to the ASD reference diameter: 22 subjects with ASD diameter 4 - 14 mm (group A); 21 subjects with ASD diameter 15 - 20 mm (group B); and 25 subjects with ASD diameter 21 - 33 mm (group C).

RESULTSASD was occluded successfully in groups A and B. In group C, occlusion failed in 2 cases; 1 case remained with a 3-mm residual shunt sustained until 6-month follow-up. However, at 6-month follow-up, no case of thromboembolism, ASO dislocation or death occurred in the three groups. The diameter of ASD measured by TTE could accurately predict the ASO size that could successfully occlude the ASD, especially in patients with ASD < 20 mm. The ASD diameter measured by TTE correlated well with ASO size (r = 0.925, P < 0.001; r = 0.976, P < 0.001; r = 0.929, P < 0.001 respectively).

CONCLUSIONSASD diameter measured by TTE can accurately estimate the size of the ASO needed for successful closure of ASD. The larger the ASD, the much larger the ASO needed. TTE is a satisfactory guiding imaging tool for ASD closure.

Adolescent ; Adult ; Aged ; Balloon Occlusion ; instrumentation ; Child ; Child, Preschool ; Echocardiography ; methods ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Humans ; Male ; Middle Aged

OBJECTIVETo evaluate the clinical value of 3D visualization method for simulating percutaneous transcatheter closure of atrial septal defect (ASD).

METHODS3D volume render method was used for visualizing ASD and surrounding structures and 3D modeling method was applied for simulate the shape of occlusion device. The size and the distance between the lower edge of device and atria-ventricular valve of simulation occluder and actual selected atrial septal occluder (ASO) were compared in 30 patients underwent successful transcatheter closure of ASD.

RESULTSThe location, geometry, size, extent of ASDs in children were displayed in 3D visualization. No significant difference was found between simulation occluder and ASO size measured from left atrium [(26.07 +/- 5.32) cm vs. (25.91 +/- 5.32) cm] and right atrium [(22.13 +/- 5.31) cm vs. (22.08 +/- 5.26) cm, all P > 0.05]. The distances from simulation occluder to mitral valves [(5.76 +/- 2.39) cm] and to tricuspid valves [(8.25 +/- 2.40) cm] were similar as ASO to atria-ventricular valves [(5.61 +/- 2.26) cm and (8.02 +/- 2.48) cm, respectively, all P > 0.05].

CONCLUSIONSThe simulating percutaneous transcatheter closure of ASD by 3D visualization technique could be a helpful noninvasive approach for ASO selection before the procedure of transcatheter occlusion of ASD.

Cardiac Catheterization ; methods ; Child ; Child, Preschool ; Computer Simulation ; Echocardiography, Three-Dimensional ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Humans ; Male ; Treatment Outcome

No abstract available.
Aged ; *Cardiac Catheterization/instrumentation ; Computed Tomography Angiography ; Coronary Angiography/methods ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal ; Female ; Heart Septal Defects, Atrial/diagnostic imaging/*therapy ; Humans ; Septal Occluder Device ; Treatment Outcome