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Presented by: Dr. Ibdah
65 year old patient ,female c/o : SOB, occasional palpitations TEE: ASD II , Left to Right Shunt. Diameter
of defect 14 mm . RV dilated with signs of volume overloading
Right heart Catheterization: PA sys 36mmHg
PVR 61 dyn/cm5 Balloon sizing :
successful transcatheter ASD closure with Amplazer device 22mm
Common 3-10% of CHD Classification: ASD I, ASD II 70%, sinus
venosus Female > Male Pathophsiology : initially left to right shunt Clinical features and diagnostic evaluation: are not the scope of this presentation!
Three questions crystallize the debate :
1.Who should have their ASD closed?2.When should it be closed? 3.How should it be closed?
Any patient with dilated RV or RA by Echo,MRT or CT
any ASD ( in the absence of of advanced pulmonary HTN) with one or more of following:
1.ASD > 10 mm on TEE2.Qp:Qs > 1.5:1
Yes close it and yes do it as soon as possible !
Is the age matter ? The answer is NO
The defect too small follow them periodically
Severe pulmonary arterial HTN ; do not close ! ASD acts here as ``pop-off`` valve
Pregnancy defer 6 months after delivery Severe LV dysfunction . Again ASD
functioning as`` pop-off`` valve
Device closure is a safe and effective procedure in experienced hands
Advantages of device closure : less hospital stay, avoidance surgical wounds,
same hemodynamic benefit as by surgery Drawbacks: large defect > 36 mm, septal rim less
than 5 mm, proximity of defect to AV ,CS,IVC,SVC
Successful closure achieved in 95 % of Pt. Tachyarrhythmia 1-4% follow up , ablation Brady arrhythmia Pacing Device migration and erosion : catastrophic but
rare 0,1 %related to operator experience and over sizing
Right heart failure or progressive pulmonary HTN ; related to the age of patient at the time of closure
Thrombosis 1.2 %: maximal at 4 weeks ,rare with dual therapy era
Nickel allergy ! Chest pain at next day do skin test if positive remove the device
Small: common after catheter closure ,close spontaneously after 1 year
Large : false measurement, dehisced ASD device
Dual antiplatelet therapy 6 months TTE next day . TEE in 1,6 and in 12 months IE-prophylaxis for 6 months
Majority of ASD II are device closable Safe and effective procedure need for excellent pre-procedure work up
Thank you for your attention