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Transcatheter Closure of ASDs and PFOs
A Comprehensive Assessment
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Transcatheter Closure
ASD PFO
s s
of and
A Comprehensive Assessment
Ziyad M. Hijazi
, MD, MPH, FSCAI, FACC, FAAP
Director of the Rush Center for Congenital and Structural Heart Disease, Pediatric Cardiology
Section Chief, and Professor of Pediatrics and Internal Medicine, Rush University Medical
Center, Chicago, Illinois
Ted Feldman
, MD, FSCAI, FACC, FESC
Director of the Cardiac Catheterization Laboratory, NorthShore University HealthSystem–
Evanston Hospital, Evanston, Illinois
Mustafa H. Abdullah Al-Qbandi
, MD, DCH, FAAP, FRCPC, FAAC, FSCAI
Consultant Pediatrician, Pediatric Cardiologist, and Head of Pediatric Cardiology Unit,
Chest Diseases Hospital, Kuwait Cardiac Centre, Kuwait
Horst Sievert
, MD, FSCAI, FACC, FESC, FICA
Director of the CardioVascular Center Frankfurt, Sankt Katharinen Hospital, Frankfurt;
Director of the Department of Internal Medicine, Cardiology and Vascular Medicine,
Sankt Katharinen Hospital, Frankfurt; Professor of Medicine, Johann Wolfgang Goethe
University, Frankfurt, Germany
Minneapolis, Minnesota
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© 2010 Ziyad M. Hijazi, Ted Feldman, Mustafa H. Abdullah Al-Qbandi, and Horst Sievert
Cardiotext Publishing, LLC
3405 W. 44th Street
Minneapolis, MN 55410
USA
www.cardiotextpublishing.com Contents
Any updates to this book may be found at: www.cardiotextpublishing.com/titles/detail/9780979016493
Supplemental video content for this book may be found at: www.cardiotextpublishing.com/sites/transcatheter-closure/
Devices on the front cover (left to right): AMPLATZER Septal Occluder, AGA Medical Corporation; BioSTAR Septal Occluder,
NMT Medical, Inc.; GORE HELEX Septal Occluder, W.L. Gore & Associates; Figulla Flex, Occlutech; Coherex FlatStent EF,
Coherex Medical, Inc. All devices are reprinted with permission. All rights reserved.
Comments, inquiries, and requests for bulk sales can be directed to the publisher at: [email protected].
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the
publisher.
All trademarks, service marks, and trade names used herein are the property of their respective owners and are used only to identify the prod-
ucts or services of those owners.
This book is intended for educational purposes and to further general scientific and medical knowledge, research, and understanding of the
conditions and associated treatments discussed herein. This book is not intended to serve as and should not be relied upon as recommending
or promoting any specific diagnosis or method of treatment for a particular condition or a particular patient. It is the reader’s responsibility to
determine the proper steps for diagnosis and the proper course of treatment for any condition or patient, including suitable and appropriate
tests, medications or medical devices to be used for or in conjunction with any diagnosis or treatment.
Due to ongoing research, discoveries, modifications to medicines, equipment and devices, and changes in government regulations, the in-
formation contained in this book may not reflect the latest standards, developments, guidelines, regulations, products or devices in the field.
Readers are responsible for keeping up to date with the latest developments and are urged to review the latest instructions and warnings for
any medicine, equipment or medical device. Readers should consult with a specialist or contact the vendor of any medicine or medical device
where appropriate.
Except for the publisher’s website associated with this work, the publisher is not affiliated with and does not sponsor or endorse any websites,
organizations or other sources of information referred to herein.
The publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of
any of the contents of this book.
Unless otherwise stated, all figures and tables in this book are used courtesy of the authors.
∞ Printed on acid-free paper.
This book is printed on 100% FSC-certified paper from well-managed forests, where people,
wildlife, and the environment benefit from the forestry practices. Forest Stewardship Council
SW-COC-001271
certification is globally recognized for ensuring well-managed forests.
Cover and book design by Zan Ceeley, Trio Bookworks
Library of Congress Control Number: 2010924349
ISBN-13: 978-0-9790164-9-3
Printed in Canada
15 14 13 12 11 10 1 2 3 4 5 6 7 8 9 10
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Contents
About the Contributors ix
Foreword by Charles E. Mullins xv
Preface xvii
Acknowledgments xix
Part I: Anatomy, Pathophysiology, and Natural History
1. Anatomy of the Atrial Septum 3
Akash R. Patel, Lisa C. A. D’Alessandro, and Paul M. Weinberg
2. Natural and Unnatural History of a Secundum ASD 17
Gregory A. Fleming, Thomas Doyle, and Thomas P. Graham Jr.
3. ASDs: Clinical Perspectives 27
Wail Alkashkari and Ziyad M. Hijazi
4. Historical Perspectives on ASD Device Closure 37
Terry Dean King and Noel L. Mills
5. PFO Closure for Prevention of Recurrent Stroke and TIA 65
Ted Feldman
v
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vi Contents
6. PFO Closure and Migraines 73
Jonathan Tobis and Swarnendra Verma
Part II: Imaging and Assessment
7. Imaging to Guide ASD and PFO Closure: TTE and TEE 97
Sinai C. Zyblewski and Girish S. Shirali
8. Imaging to Guide ASD and PFO Closure: Intracardiac Echocardiography 111
Mustafa H. Abdullah Al-Qbandi, Qi-Ling Cao, and Ziyad M. Hijazi
9. CT Evaluation of the Interatrial Septum in ASDs 125
Robert A. Quaife and John D. Carroll
10. Cardiac Magnetic Resonance Assessment of ASDs and PFOs:
Relation to Device Closure, Pre and Post 139
Mark A. Fogel
Part III: Procedure Techniques
11. Establishing a Program in Structural Heart Disease Interventional Therapies 159
Ted Feldman and Ziyad M. Hijazi
12. How to Close Simple ASDs 167
Matthew Egan and Ralf J. Holzer
13. Device Closure of Difficult ASDs 177
Mustafa H. Abdullah Al-Qbandi and Ziyad M. Hijazi
14. Device Closure of ASDs in Small Children 197
Mustafa H. Abdullah Al-Qbandi and Ziyad M. Hijazi
15. Device Closure of ASDs and PFOs in the Elderly:
Hemodynamic Assessment 205
Mehmet Cilingiroglu and Ted Feldman
16. Closure of ASDs with Pulmonary Hypertension:
Assessing Operability 213
Sara M. Trucco and William E. Hellenbrand
17. Device Closure of ASDs in Patients with R-L Shunt 229
Anas Salkini and John W. Moore
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Contents vii
18. Device Closure of Fenestrations Post Fontan Operation 243
Mustafa H. Abdullah Al-Qbandi and Ziyad M. Hijazi
19. Unusual Vascular Access to Close ASDs and PFOs 251
Larry A. Latson
20. Transcatheter ASD Closure without Fluoroscopy 257
Peter Ewert and Felix Berger
21. New Minimally Invasive Techniques for Surgical Closure of ASDs and PFOs 263
Nikolay V. Vasilyev and Pedro J. del Nido
22. Complications of Device Closure of ASDs and PFOs 271
Zahid Amin
23. Nightmare Cases in the Cardiac Catheterization Laboratory
during Percutaneous Closure of ASDs 283
Mustafa H. Abdullah Al-Qbandi, Tarek S. Momenah, and Ziyad M. Hijazi
24. My Worst Nightmare Cases of PFO Closure 293
Tina Lehr, Sonya Joy, Kristina Renkhoff, Nina Wunderlich, and Horst Sievert
Part IV: Devices
25. Engineering Aspects of Metallic and Bioabsorbable Devices 305
Carol A. Devellian, Stephanie M. Kladakis, Steven W. Opolski, and John A. Wright Jr.
26. The AMPLATZER Devices for ASDs and PFOs 351
Trong-Phi Lê and Horst Sievert
27. The GORE HELEX Septal Occluder 355
Ted Feldman
28. The Occlutech Flex Devices for ASD and PFO Closure 371
Nicolas Majunke, Nina Wunderlich, and Horst Sievert
29. Transcatheter Patch Device 373
Basilios E. Sideris, John D. Coulson, and Eleftherios B. Sideris
30. The CardioSEAL/STARFlex Family of Devices
for Closure of Atrial-Level Defects 383
Paul Kramer
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viii Contents
31. Bioabsorbable Devices: The BioSTAR and BioTREK for ASDs and PFOs 401
Ryan Ko and Michael J. Mullen
32. Cardia Devices 407
Daniel R. Turner and Thomas J. Forbes
33. The Solysafe Septal Occluder for the Closure of ASDs and PFOs 417
Peter Ewert
34. The pfm Device for ASD Closure 423
Miguel Granja and Franz Freudenthal
35. The Coherex FlatStent 431
Olaf Franzen and Stephan Baldus
36. The St. Jude Medical Premere Device for PFO Closure 439
Jennifer Franke, Stefan Bertog, and Horst Sievert
Index 443
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