Skip to main content
Log in

Interventioneller Verschluss von Vorhofseptumdefekt, persistierendem Foramen ovale und Ventrikelseptumdefekt

Interventional closure of atrial septal defects, patent oval foramen and ventricular septal defects

  • Schwerpunkt
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Der interventionelle Verschluss kongenitaler Shunt-Vitien ist zu einem in der klinischen Routine etablierten Verfahren herangereift. So stellt der Katheterverschluss mittlerweile die Therapie der Wahl in der Behandlung des ASD dar. Er ist in fast allen Fällen der Defekte vom Sekundumtyp anatomisch möglich und mit einer Erfolgsrate von über 99 % technisch durchführbar. Der Eingriff kann in der Regel ohne Vollnarkose durchgeführt werden und erfordert nur einen kurzen Krankenhausaufenthalt. Das PFO ist eine potenzielle Durchtrittspforte für paradoxe Embolien. Diese können zu embolischen Schlaganfällen bzw. peripheren Embolien führen. Der Katheterverschluss hat im Vergleich zu einer lebenslangen Antikoagulation viele Vorteile und ist für manche Patienten die einzige therapeutische Option. Randomisierte Studien haben gezeigt, dass der interventionelle Verschluss zu Ergebnissen führt, die der medikamentösen Therapie vergleichbar sind. Bei einigen Okkludertypen gelang sogar der Nachweis signifikanter Vorteile gegenüber der medikamentösen Behandlung. Auch VSD einschließlich perimembranöser Defekte können in vielen Fällen kathetertechnisch verschlossen werden. Dies gilt sogar für VSD, die durch eine Ruptur des Septums infolge eines Myokardinfarkts entstanden sind.

Abstract

Percutaneous transcatheter closure techniques and devices for congenital intracardiac shunts have considerably improved; therefore, catheter closure is now the treatment of choice for atrial septal defects (ASD). This is technically feasible in more than 80 % of patients with a secundum ASD and the success rate is higher than 99 %. General anesthesia is as a rule unnecessary and the hospital stay is very short. A patent oval foramen (POF) is a potential cause of cryptogenic stroke and peripheral embolisms. The catheter occlusion has many advantages in comparison to lifelong anticoagulation therapy and for some patients it is the only therapeutic option. Randomized trials have shown that interventional closure leads to results which are comparable to drug therapy and for some occlusion systems even evidence of significant advantages compared to drug therapy was found. Even ventricular septal defects (VSD), including perimembraneous and post-myocardial infarction VSDs can be closed by catheter techniques with a high success rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Gatzoulis MA, Redington AN, Somerville J, Shore DF (1996) Should atrial septal defects in adults be closed? Ann Thorac Surg 61(2):657–659

    Article  CAS  PubMed  Google Scholar 

  2. Attie F, Rosas M, Granados N, Zabal C, Buendia A, Calderon J (2001) Surgical treatment for secundum atrial septal defects in patients > 40 years old. A randomized clinical trial. J Am Coll Cardiol 38(7):2035–2042

    Article  CAS  PubMed  Google Scholar 

  3. Konstantinides S, Geibel A, Olschewski M et al (1995) A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 333(8):469–473

    Article  CAS  PubMed  Google Scholar 

  4. Murphy JG, Gersh BJ, McGoon MD et al (1990) Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27–32 years. N Engl J Med 323(24):1645–1650

    Article  CAS  PubMed  Google Scholar 

  5. Helber U, Baumann R, Seboldt H, Reinhard U, Hoffmeister HM (1997) Atrial septal defect in adults: cardiopulmonary exercise capacity before and 4 months and 10 years after defect closure. J Am Coll Cardiol 29(6):1345–1350

    Article  CAS  PubMed  Google Scholar 

  6. Baumgartner H, Bonhoeffer P, De Groot NM et al (2010) ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 31(23):2915–2957

    Article  PubMed  Google Scholar 

  7. King TD, Thompson SL, Steiner C, Mills NL (1976) Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA 235(23):2506–2509

    Article  CAS  PubMed  Google Scholar 

  8. Mills NL, King TD (1976) Nonoperative closure of left-to-right shunts. J Thorac Cardiovasc Surg 72(3):371–378

    CAS  PubMed  Google Scholar 

  9. Rashkind WJ (1983) Transcatheter treatment of congenital heart disease. Circulation 67(4):711–716

    Article  CAS  PubMed  Google Scholar 

  10. Sideris EB, Sideris SE, Fowlkes JP, Ehly RL, Smith JE, Gulde RE (1990) Transvenous atrial septal defect occlusion in piglets with a „buttoned“ double-disk device. Circulation 81(1):312–318

    Article  CAS  PubMed  Google Scholar 

  11. Sideris EB, Sideris SE, Thanopoulos BD, Ehly RL, Fowlkes JP (1990) Transvenous atrial septal defect occlusion by the buttoned device. Am J Cardiol 66(20):1524–1526

    Article  CAS  PubMed  Google Scholar 

  12. Rome JJ, Keane JF, Perry SB, Spevak PJ, Lock JE (1990) Double-umbrella closure of atrial defects. Initial clinical applications. Circulation 82(3):751–758

    Article  CAS  PubMed  Google Scholar 

  13. Kreutzer J, Ryan CA, Wright JA Jr et al (2000) Acute animal studies of the STARFlex system: a new self-centering cardioSEAL septal occluder. Catheter Cardiovasc Interv 49(2):225–233

    Article  CAS  PubMed  Google Scholar 

  14. Sievert H, Babic UU, Hausdorf G et al (1998) Transcatheter closure of atrial septal defect and patent foramen ovale with ASDOS device (a multi-institutional European trial). Am J Cardiol 82(11):1405–1413

    Article  CAS  PubMed  Google Scholar 

  15. Rickers C, Hamm C, Stern H et al (1998) Percutaneous closure of secundum atrial septal defect with a new self centering device („angel wings“). Heart 80(5):517–521

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Latson LA, Zahn EM, Wilson N (2000) Helex septal occluder for closure of atrial septal defects. Curr Interv Cardiol Rep 2(3):268–273

    PubMed  Google Scholar 

  17. Chan KC, Godman MJ, Walsh K, Wilson N, Redington A, Gibbs JL (1999) Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience. Heart 82(3):300–306

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Fischer D, Haentjes J, Klein G et al (2011) Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism: procedural and follow-up results after implantation of the Amplatzer®-occluder device. J Interv Cardiol 24(1):85–91

    Article  PubMed  Google Scholar 

  19. Ivens E, Hamilton-Craig C, Aroney C, Clarke A, Jalali H, Burstow DJ (2009) Early and late cardiac perforation by Amplatzer atrial septal defect and patent foramen ovale devices. J Am Soc Echocardiogr 22(9):1067–1070

    Article  PubMed  Google Scholar 

  20. Amin Z, Hijazi ZM, Bass JL, Cheatham JP, Hellenbrand W, Kleinman CS (2008) PFO closure complications from the AGA registry. Catheter Cardiovasc Interv 72(1):74–79

    PubMed  Google Scholar 

  21. Roos-Hesselink JW, Meijboom FJ, Spitaels SE et al (2003) Excellent survival and low incidence of arrhythmias, stroke and heart failure long-term after surgical ASD closure at young age. A prospective follow-up study of 21–33 years. Eur Heart J 24(2):190–197

    Article  CAS  PubMed  Google Scholar 

  22. Berger F, Vogel M, Alexi-Meskishvili V, Lange PE (1999) Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg 118(4):674–678. (discussion 678–680)

    Article  CAS  PubMed  Google Scholar 

  23. Butera G, Carminati M, Chessa M et al (2006) Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications. Am Heart J 151(1):228–234

    Article  PubMed  Google Scholar 

  24. Fischer G, Stieh J, Uebing A, Hoffmann U, Morf G, Kramer HH (2003) Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart 89(2):199–204

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  25. Humenberger M, Rosenhek R, Gabriel H et al (2011) Benefit of atrial septal defect closure in adults: impact of age. Eur Heart J 32(5):553–560

    Article  PubMed Central  PubMed  Google Scholar 

  26. Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S (1992) Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 117(6):461–465

    Article  PubMed  Google Scholar 

  27. Hagen PT, Scholz DG, Edwards WD (1984) Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 59(1):17–20

    Article  CAS  PubMed  Google Scholar 

  28. Penther P (1994) Patent foramen ovale: an anatomical study. Apropos of 500 consecutive autopsies. Arch Mal Coeur et Vaiss 87(1):15–21

    CAS  Google Scholar 

  29. Comess KA, DeRook FA, Beach KW, Lytle NJ, Golby AJ, Albers GW (1994) Transesophageal echocardiography and carotid ultrasound in patients with cerebral ischemia: prevalence of findings and recurrent stroke risk. J Am Coll Cardiol 23(7):1598–1603

    Article  CAS  PubMed  Google Scholar 

  30. Bridges ND, Hellenbrand W, Latson L, Filiano J, Newburger JW, Lock JE (1192) Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation 86(6):1902–1908

    Article  Google Scholar 

  31. Wohrle J (2006) Closure of patent foramen ovale after cryptogenic stroke. Lancet 368(9533):350–352

    Article  PubMed  Google Scholar 

  32. Windecker S, Wahl A, Chatterjee T et al (2001) Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. Circulation 101(8):893–898

    Article  Google Scholar 

  33. Furlan AJ, Reisman M, Massaro J et al (2012) Closure or medical therapy for cryptogenic stroke with patent foramen ovale. N Engl J Med 366(11):991–999

    Article  CAS  PubMed  Google Scholar 

  34. Meier B, Kalesan B, Mattle HP et al (2013) Percutaneous closure of patent foramen ovale in cryptogenic embolism. N Engl J Med 368(12):1083–1091

    Article  CAS  PubMed  Google Scholar 

  35. Carroll JD, Saver JL, Thaler DE et al (2013) Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med 368(12):1092–1100

    Article  CAS  PubMed  Google Scholar 

  36. Rengifo-Moreno P, Palacios IF, Junpaparp P, Witzke CF, Morris DL, Romero-Corral A (2013) Patent foramen ovale transcatheter closure vs. medical therapy on recurrent vascular events: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J 34(43):3342–3352

    Article  PubMed  Google Scholar 

  37. Hornung M, Bertog SC, Franke J et al (2013) Long-term results of a randomized trial comparing three different devices for percutaneous closure of a patent foramen ovale. Eur Heart J 34(43):3362–3369

    Article  PubMed  Google Scholar 

  38. Zimmermann WJ, Heinisch C, Majunke N et al (2010) Patent foramen ovale closure with the SeptRx device initial experience with the first „In-Tunnel“ device. JACC Cardiovasc Interv 3(9):963–967

    Article  PubMed  Google Scholar 

  39. Sievert H, Wunderlich N, Reiffenstein I et al (2014) Initial clinical experience with the Coherex FlatStent and FlatStent EF PFO closure system for in-tunnel PFO closure: results of the Coherex-EU study. Catheter Cardiovasc Interv 83(7):1135–1143

    Article  PubMed  Google Scholar 

  40. Mullen MJ, Devellian CA, Jux C (2007) BioSTAR bioabsorbable septal repair implant. Expert Rev Med Devices 4(6):781–792

    Article  PubMed  Google Scholar 

  41. Liu SJ, Peng KM, Hsiao CY, Liu KS, Chung HT, Chen JK (2011) Novel biodegradable polycaprolactone occlusion device combining nanofibrous PLGA/collagen membrane for closure of atrial septal defect (ASD). Ann BioMed Eng 39(11):2759–2766

    Article  PubMed  Google Scholar 

  42. Wu W, Yip J, Tang YD et al (2011) A novel biodegradable septal defect occluder: the „Chinese Lantern“ design, proof of concept. Innovations 6(4):221–230

    PubMed  Google Scholar 

  43. Lindinger A, Schwedler G, Hense HW (2010) Prevalence of congenital heart defects in newborns in Germany: Results of the first registration year of the PAN Study (July 2006 to June 2007). Klin Padiatr 222(5):321–326

    Article  CAS  PubMed  Google Scholar 

  44. Krovetz LJ (1998) Spontaneous closure of ventricular septal defect. Am J Cardiol 81(1):100–101

    Article  CAS  PubMed  Google Scholar 

  45. Soufflet V, Van de Bruaene A, Troost E et al (2010) Behavior of unrepaired perimembranous ventricular septal defect in young adults. Am J Cardiol 105(3):404–407

    Article  PubMed  Google Scholar 

  46. Lock JE, Block PC, McKay RG, Baim DS, Keane JF (1988) Transcatheter closure of ventricular septal defects. Circulation 78(2):361–368

    Article  CAS  PubMed  Google Scholar 

  47. O'Laughlin MP, Mullins CE (1989) Transcatheter occlusion of ventricular septal defect. Catheter Cardiovasc Diagn 17(3):175–179

    Article  Google Scholar 

  48. Rigby ML, Redington AN (1994) Primary transcatheter umbrella closure of perimembranous ventricular septal defect. Br Heart J 72(4):368–371

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  49. Hijazi ZM, Hakim F, Al-Fadley F, Abdelhamid J, Cao QL (2000) Transcatheter closure of single muscular ventricular septal defects using the amplatzer muscular VSD occluder: initial results and technical considerations. Catheter Cardiovasc Interv 49(2):167–172

    Article  CAS  PubMed  Google Scholar 

  50. Amin Z, Berry JM, Foker JE, Rocchini AP, Bass JL (1998) Intraoperative closure of muscular ventricular septal defect in a canine model and application of the technique in a baby. J Thorac Cardiovascu Surg 115(6):1374–1376

    Article  CAS  Google Scholar 

  51. Carminati M, Butera G, Chessa M et al (2007) Transcatheter closure of congenital ventricular septal defects: results of the European Registry. Eur Heart J 28(19):2361–2368

    Article  PubMed  Google Scholar 

  52. Li P, Zhao XX, Zheng X, Qin YW (2012) Arrhythmias after transcatheter closure of perimembranous ventricular septal defects with a modified double-disk occluder: early and long-term results. Heart Vessels 27(4):405–410

    Article  CAS  PubMed  Google Scholar 

  53. Tzikas A, Ibrahim R, Velasco-Sanchez D et al (2014) Transcatheter closure of perimembranous ventricular septal defect with the Amplatzer(®) membranous VSD occluder 2: initial world experience and one-year follow-up. Catheter Cardiovasc Interv 83(4):571–580

    Article  PubMed  Google Scholar 

  54. Chungsomprasong P, Durongpisitkul K, Vijarnsorn C, Soongswang J, Le TP (2011) The results of transcatheter closure of VSD using Amplatzer® device and Nit Occlud® Lê coil. Catheter Cardiovasc Interv 78(7):1032–1040

    Article  PubMed  Google Scholar 

  55. Crenshaw BS, Granger CB, Birnbaum Y et al (2000) Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 101(1):27–32

    Article  CAS  PubMed  Google Scholar 

  56. Zhu XY, Qin YW, Han YL et al (2013) Long-term efficacy of transcatheter closure of ventricular septal defect in combination with percutaneous coronary intervention in patients with ventricular septal defect complicating acute myocardial infarction: a multicentre study. EuroIntervention 8(11):1270–1276

    Article  PubMed  Google Scholar 

  57. Yang L, Tai BC, Khin LW, Quek SC (2014) A systematic review on the efficacy and safety of transcatheter device closure of ventricular septal defects (VSD). J Interv Cardiol 27(3):260–272

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Horst Sievert.

Ethics declarations

Interessenkonflikt

Das Zentrum der Autoren erhielt Studienhonorare, Beratungs- oder Reisekosten von oder hält Beteiligungen an folgenden Firmen: Abbott, Access Closure, AGA, Angiomed, Arstasis, Atritech, Atrium, Avinger, Bard, Boston Scientific, Bridgepoint, Cardiac Dimensions, CardioKinetix, CardioMEMS, Coherex, Contego, CSI, EndoCross, EndoTex, Epitek, Evalve, ev3, FlowCardia, Gore, Guidant, Guided Delivery Systems Inc., InSeal Medical, Lumen Biomedical, HLT, Kensey Nash, Kyoto Medical, Lifetech, Lutonix, Medinol, Medtronic, NDC, NMT, OAS, Occlutech, Osprey, Ovalis, Pathway, PendraCare, Percardia, pfm Medical, Rox Medical, Sadra, SJM, Sorin, Spectranetics, SquareOne, Trireme, Trivascular, Velocimed, Veryan.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hornung, M., Franke, J., Id, D. et al. Interventioneller Verschluss von Vorhofseptumdefekt, persistierendem Foramen ovale und Ventrikelseptumdefekt. Herz 40, 765–770 (2015). https://doi.org/10.1007/s00059-015-4331-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-015-4331-2

Schlüsselwörter

Keywords

Navigation