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Clinical Trial
. 2004 May 19:2:5.
doi: 10.1186/1476-7120-2-5.

Percutaneous closure of interatrial communications in adults - prospective embolism prevention study with two- and three-dimensional echocardiography

Fabian Knebel  1 , Volker Gliech, Torsten Walde, Alexander Panda, Wasiem Sanad, Stephan Eddicks, Gert Baumann, Adrian C Borges
Affiliations
Clinical Trial

Percutaneous closure of interatrial communications in adults - prospective embolism prevention study with two- and three-dimensional echocardiography

Fabian Knebel et al. Cardiovasc Ultrasound. .

Abstract

Background: Patients with interatrial communications after paradoxical embolic events are at risk for recurrent thromboembolism. We hypothesized that transcatheter closure of the defects would result in long-term prevention of systemic embolism and performed clinical and echocardiographic follow-up.

Methods: We included 161 patients (mean age 46.8 +/- 11 years, 83 females) with patent foramen ovale or atrial septal defect and at least one documented paradoxical systemic thrombembolic event and/or a large atrial shunting.

Results: The implantation procedure was successfully performed without major complications in all patients and minor complications in 2.5%. Two and / or three dimensional echocardiography was performed before and after 4 weeks and 12 months using a multiplane transoesophageal probe. After 4 weeks and 6 months two patients had minimal shunting. These residual defects were closed with a second device implantation without shunting after further 4 weeks. During a follow-up of 324.3 patient years (range, 13 to 19 months), recurrent embolic events occurred in only 1 patient (0.6%).

Conclusion: After primary paradoxical systemic embolism, results of transcatheter occlusion of the interatrial communications are dependent on the closure device system and can prevent further secondary embolic events for up to 1 year after the percutaneous closure. Three dimensional echocardiography provides dynamic features of the defects and the post closure status and may lead to an improved understanding and diagnosis of the interatrial defect.

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Figures

Figure 1
Figure 1
Computer reconstructed two-dimensional images of a large secundum atrial septal defect (upper panels and left lower panel) and 3D echocardiographic reconstruction (right lower panel). LA, left atrium; RA, right atrium.
Figure 2
Figure 2
3D transesophageal image of a large secundum atrial septal defect, the image shows the defect area from the left atrium; Ao, ascending aorta.
Figure 3
Figure 3
3D transesophageal image of the Amplatzer PFO Occluder (arrow), the image shows the surface of the left atrial part of the device.
Figure 4
Figure 4
Original percutaneous PFO occlusion device: Amplatzer PFO Occluder (AGA Medical, Golden Valleey, Minnesota, USA), view of the left atrial surface.
Figure 5
Figure 5
See this image and copyright information in PMC

References

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