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.
Literatur
Gatzoulis MA, Redington AN, Somerville J, Shore DF (1996) Should atrial septal defects in adults be closed? Ann Thorac Surg 61(2):657–659
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
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
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
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
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
King TD, Thompson SL, Steiner C, Mills NL (1976) Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA 235(23):2506–2509
Mills NL, King TD (1976) Nonoperative closure of left-to-right shunts. J Thorac Cardiovasc Surg 72(3):371–378
Rashkind WJ (1983) Transcatheter treatment of congenital heart disease. Circulation 67(4):711–716
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
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
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
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
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
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
Latson LA, Zahn EM, Wilson N (2000) Helex septal occluder for closure of atrial septal defects. Curr Interv Cardiol Rep 2(3):268–273
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
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
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
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
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
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)
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
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
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
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
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
Penther P (1994) Patent foramen ovale: an anatomical study. Apropos of 500 consecutive autopsies. Arch Mal Coeur et Vaiss 87(1):15–21
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
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
Wohrle J (2006) Closure of patent foramen ovale after cryptogenic stroke. Lancet 368(9533):350–352
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
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
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
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
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
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
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
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
Mullen MJ, Devellian CA, Jux C (2007) BioSTAR bioabsorbable septal repair implant. Expert Rev Med Devices 4(6):781–792
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
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
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
Krovetz LJ (1998) Spontaneous closure of ventricular septal defect. Am J Cardiol 81(1):100–101
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
Lock JE, Block PC, McKay RG, Baim DS, Keane JF (1988) Transcatheter closure of ventricular septal defects. Circulation 78(2):361–368
O'Laughlin MP, Mullins CE (1989) Transcatheter occlusion of ventricular septal defect. Catheter Cardiovasc Diagn 17(3):175–179
Rigby ML, Redington AN (1994) Primary transcatheter umbrella closure of perimembranous ventricular septal defect. Br Heart J 72(4):368–371
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
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
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
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
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
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
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
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
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
Author information
Authors and Affiliations
Corresponding author
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
About this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00059-015-4331-2