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Device closure of secundum atrial septal defect’s and the risk of cardiac erosion

Echo Research & Practice volume 2, pages R73–R78 (2015)Cite this article

Abstract

Cardiac erosion related to transcatheter atrial septal defect closure devices is of increasing concern. Erosion is reported to have occurred with most of currently available occluder devices. Perhaps due to the very large number of implants worldwide, the Amplatzer (St Jude) occluder is associated with the majority of cardiac erosion events reported in the literature. Best current estimates of the incidence of erosion with the St Jude device are between one and three cases per 1000 implants. Most events occur early after implantation and it is rare, although not unheard of, for events to occur after a year following device insertion. It is important that those involved with closure programmes are vigilant for the problem, because device-related erosion is associated with a significant mortality risk. Despite considerable debate, the risk factors (either patient or device) for erosion remain unclear and require further investigation. Currently available data sets have focussed largely on erosion cohorts and are unable to place these cases in appropriate context with non-erosion closure cases. What is certain is that programmes implanting these devices must take care to implant appropriately sized devices and have in place plans to ensure that patients are both well informed and can access help and advice in the event of developing symptoms.

References

  1. King TD, Thompson SL, Steiner C, & Mills NL 1976 Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. Journal of the American Medical Association 235 2506–2509. (doi:10.1001/jama.1976.03260490024013)

    Article  CAS  PubMed  Google Scholar 

  2. Aggoun Y, Gallet B, Acar P, Pulik M, Czitrom D, Lagier A, & Laborde F 2002 Perforation of the aorta after percutaneous closure of an atrial septal defect with an Amplatz prosthesis, presenting with acute severe hemolysis. Archives des Maladies du Coeur et des Vaisseaux 95 479–482.

    CAS  PubMed  Google Scholar 

  3. Chun DS, Turrentine MW, Moustapha A, & Hoyer MH 2003 Development of aorta-to-right atrial fistula following closure of secundum atrial septal defect using the Amplatzer septal occluder. Catheterization and Cardiovascular Interventions 58 246–251. (doi:10.1002/ccd.10434)

    Article  PubMed  Google Scholar 

  4. Divekar A, Gaamangwe T, Shaikh N, Raabe M, & Ducas J 2005 Cardiac perforation after device closure of atrial septal defects With the Amplatzer septal occluder. Journal of the American College of Cardiology 45 1213–1218. (doi:10.1016/j.jacc.2004.12.072)

    Article  PubMed  Google Scholar 

  5. Amin Z, Hijazi ZM, Bass JL, Cheatham JP, Hellenbrand WE, & Kleinman CS 2004 Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects: review of registry of complications and recommendations to minimize future risk. Catheterization and Cardiovascular Interventions 63 496–502. (doi:10.1002/ccd.20211)

    Article  PubMed  Google Scholar 

  6. DiBardino DJ, McElhinney DB, Kaza AK, Mayer JE, Jr 2009 Analysis of the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience database for adverse events involving Amplatzer septal occluder devices and comparison with the Society of Thoracic Surgery congenital cardiac surgery database. Journal of Thoracic and Cardiovascular Surgery 137 1334–1341. (doi:10.1016/j.jtcvs.2009.02.032)

    Article  PubMed  Google Scholar 

  7. Diab K, Kenny D, & Hijazi ZM 2012 Erosions, erosions and erosions! Device closure of atrial septal defects: how safe is safe? Catheterization and Cardiovascular Interventions 80 168–174. (doi:10.1002/ccd.24517)

    Article  PubMed  Google Scholar 

  8. Beg K, Latson LA, Pettersson G, Wallace L, & Qureshi AM 2015 Aorta-to-left atrial fistula developing after surgical removal of an atrial septal occlusion device eight years after original implantationN. World Journal for Pediatric & Congenital Heart Surgery 6 320–323. (doi:10.1177/2150135114561688)

    Article  Google Scholar 

  9. U.S. FDA. FDA Executive Summary Memorandum–May 24, 2012: Circulatory System Advisory Panel Meeting–Transcatheter ASD Occluders: Clinical Update and Review of Events [pdf]. May 24, 2012. (available at: http://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/CirculatorySystemDevicesPanel/ucm300073.htm

    Google Scholar 

  10. Moore J, Hegde S, El-Said H, Beekman R, III, Benson L, Bergersen L, Holzer R, Jenkins K, Ringel R, & Rome J 2013 Transcatheter device closure of atrial septal defects. A safety review. JACC. Cardiovascular Interventions 5 433–442. (doi:10.1016/j.jcin.2013.02.005)

    Article  Google Scholar 

  11. Amin Z 2014 Echocardiographic predictors of cardiac erosion after Amplatzer septal occluder placement. Catheterization and Cardiovascular Interventions 83 84–92. (doi:10.1002/ccd.25175)

    Article  PubMed  Google Scholar 

  12. Podnar T, Martanovic P, Gavora P, & Masura J 2001 Morphological variations of secundum-type atrial septal defects: feasibility for percutaneous closure using Amplatzer septal occluders. Catheterization and Cardiovascular Interventions 53 386–391. (doi:10.1002/ccd.1187)

    Article  CAS  PubMed  Google Scholar 

  13. Kitano M, Yazaki S, Sugiyama H, & Yamada O 2009 The influence of morphological changes in Amplatzer device on the atrial and aortic walls following transcatheter closure of atrial septal defects. Journal of Interventional Cardiology 22 83–91. (doi:10.1111/j.1540-8183.2008.00421.x)

    Article  PubMed  Google Scholar 

  14. Bhaya M, Mutluer F, Mahan E, Mahan L, Hsiung MC, Yin WH, Wei J, Tsai SK, Zhao GY, & Yin WH 2013 Live/Real time three-dimensional transesophageal echocardiography in percutaneous closure of atrial septal defects. Echocardiography 30 345–353. (doi:10.1111/echo.12106)

    Article  PubMed  Google Scholar 

  15. Santini F, Morjan M, Onorati F, Morando G, Faggian G, & Mazzucco A 2012 Life-threatening isometric-exertion related cardiac perforation 5 years after Amplatzer septal defect closure: should isometric activity be limited in septal occluder holders? Annals of Thoracic Surgery 93 671(doi:10.1016/j.athoracsur.2011.07.068)

    Article  PubMed  Google Scholar 

  16. El-Said HG, & Moore JW 2009 Erosion by the Amplatzer septal occluder: experienced operator opinions at odds with manufacturer recommendations? Catheterization and Cardiovascular Interventions 73 925–930. (doi:10.1002/ccd.21931)

    Article  PubMed  Google Scholar 

  17. Wagdi P 2011 Closure of intra-atrial septal communications: Adverse events and lessons learned. Cardiology Research 2 7–15.

    PubMed  PubMed Central  Google Scholar 

  18. Hernández Pérez FJ, Fernández Díaz JA, García Montero C, García Touchard A, Oteo Domínguez JF, Domínguez Puente JR, Goicolea Ruigómez J 2013 Late aortic perforation with a fractured ATRIASEPT II device resulting in life-threatening tamponade. EuroIntervention 9 532

    Article  PubMed  Google Scholar 

  19. Happel CM, Laser KT, Sigler M, Kececioglu D, Sandica E, & Haas NA 2015 Single center experience: implantation failures, early, and late complications after implantation of a partially biodegradable ASD/PFO-device (BioStar®). Catheterization and Cardiovascular Interventions 85 990–997. (doi:10.1002/ccd.25783)

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Congenital Cardiology, Leeds General Infirmary, E Floor, Jubilee Wing, Leeds, LS1 3EX, UK

    J. D. R. Thomson BM BS MD FRCP & S. A. Qureshi MBChB FRCP

  2. Department of Paediatric Cardiology, Evelina London Childrens Hospital, Westminster Bridge Road, London, SE1 7EH, UK

    J. D. R. Thomson BM BS MD FRCP

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  1. J. D. R. Thomson BM BS MD FRCP
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  2. S. A. Qureshi MBChB FRCP
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Correspondence to J. D. R. Thomson BM BS MD FRCP.

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Thomson, J.D.R., Qureshi, S.A. Device closure of secundum atrial septal defect’s and the risk of cardiac erosion. Echo Res Pract 2, R73–R78 (2015). https://doi.org/10.1530/ERP-15-0023

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  • DOI: https://doi.org/10.1530/ERP-15-0023

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Echo Research & Practice

ISSN: 2055-0464

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