Twin Device Closure of Interatrial Septal Defects
(A) X-plane image of TEE shows two secundum type atrial septal defect (ASD). (B) Transesophageal echocardiogram (TEE) image shows closure of smaller defect with left-to-right shunt at the level of the second ASD. (C) Two-dimensional TEE image of interpositioning of two Amplatzer™ (St. Jude Medical; St. Paul, MN) with no residual defect. (D) Three-dimensional TEE image of twin Amplatzer™.
Atrial septal defects (ASDs) are among the most common congenital heart diseases that may escape diagnosis during childhood. Ostium secundum type ASD is the most frequent form of these defects. Also, it is possible that secundum type ASD presents as multiple defects.
Closure of ostium secundum type ASD via percutaneous approach is one of the earliest types of structural heart disease procedures with high success rate. Mostly, it has been performed for single defects with sufficient rims around the hole. When there is more than one defect, surgical closure is an approved approach, but there is still some chance for interventional occlusion, particularly if there is a smaller than 7-mm distance between the defects plus enough tissue around the defects for a single device to lay over them. If the distance between the defects is more, we may need double device insertion.
In this case, a 28-year-old gentleman presented with occasional palpitation and some unexplained dyspnea. On his workup, he was diagnosed with twin ASDs that can be appreciated on X-plane views (A) of transesophageal echocardiography, with left-to-right shunt. The sizes of the defects were 9 and 12 mm, with stretching sizes of 10 and 14 mm, respectively. Because the distance between the defects was more than 7 mm, we selected 12 mm and 16.5 mm Amplatzer™ (St. Jude Medical; St. Paul, MN) devices and closed them one by one. First the smaller occluder was deployed (B), and then the second one was positioned alongside it. Because there was some residual shunt, a second try was performed by pulling the right-side disc of the first device with interpositioning of the discs between each other (C-D). There was no shunt with this maneuver, and both devices were released successfully.
Date: July 30, 2018
Source: ACC Media File
Citation: Rajaei Cardivascular Medical and Research Center
Keywords: Diagnostic Imaging, Heart Septal Defects, Atrial, Vascular Closure Devices, Septal Occluder Device, Heart Defects, Congenital