Der Kardiologe

, Volume 2, Issue 1, pp 39–48

Interventioneller Verschluss von Vorhofseptumdefekten (ASD) und persistierender Foramen ovale (PFO)

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Zusammenfassung

Der Vorhofseptumdefekt ist der zweithäufigste angeborene Herzfehler. Unbehandelt führt er zur Rechtsherzbelastung. Die häufigste Form, der Vorhofseptumdefekt vom Secundum-Typ, lässt sich heute zu 80% interventionell verschließen. Ein persistierendes Foramen ovale kann eine mögliche Ursache einer paradoxen Embolie sein. Sein Verschluss ist interventionell mit hoher Erfolgsrate möglich und stellt eine Rezidivprophylaxe dar. Er konkurriert mit der medikamentösen Antikoagulation. Ob dem Verschluss auch eine therapeutische Wirkung in der Migränebehandlung zukommen kann, ist Gegenstand laufender Studien. Die interventionelle Technik zum Verschluss von Vorhofdefekten ist in der Hand des Erfahrenen zu einem komplikationsarmen Verfahren gereift, das der Operation vorzuziehen ist. Es ist vom Kindesalter bis ins hohe Alter einsetzbar.

Schlüsselwörter

Vorhofseptumdefekt Rechtsherzversagen Persistierendes Foramen ovale Paradoxe Embolie Interventioneller Defektverschluss 

Interventional closure of atrial septal defects (ASD) and persistent foramen ovale (PFO)

Abstract

Atrial septal defects are the second most common congenital heart defect. If left untreated, they lead to right heart overload. The most common form, atrial septal defect of the secundum type, can now be closed by transcatheter technique in 80% of patients. A persistent foramen ovale can be a possible cause of paradoxial embolism. Transcatheter closure by transcatheter technique has a high success rate and is a recurrence prevention measure. It is an alternative to drug-induced anticoagulation. Ongoing studies are examining whether closure may have a therapeutic effect in the treatment of migraine. The interventional technique used to close atrial defects has become a low-risk procedure if performed by an experienced physician and is preferable to surgery. It can be used in patients from childhood to old ages.

Keywords

Atrial septal defect Right heart failure Persistent foramen ovale Paradoxial embolism Transcatheter defect closure 

Literatur

  1. 1.
    Amin Z, Hijazi ZM, Bass JL et al. (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. Catheter Cardiovasc Interv 63: 496–502PubMedCrossRefGoogle Scholar
  2. 2.
    Berger F, Ewert P, Bjornstad PG et al. (1999) Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer Septal Occluder. Cardiol Young 9: 468–473PubMedGoogle Scholar
  3. 3.
    Berger F, Ewert P, Bjornstad PG et al. (1999) Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer Septal Occluder. Cardiol Young 9: 468–473PubMedGoogle Scholar
  4. 4.
    Berger F, Vogel M, Kramer A et al. (1999) Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg 68: 75–78PubMedCrossRefGoogle Scholar
  5. 5.
    Cardenas L, Panzer J, Boshoff D et al. (2007) Transcatheter closure of secundum atrial defect in small children. Catheter Cardiovasc Interv 69: 447–452PubMedCrossRefGoogle Scholar
  6. 6.
    Ewert P, Berger F, Daehnert I et al. (2000) Transcatheter closure of atrial septal defects without fluoroscopy: feasibility of a new method. Circulation 101: 847–849PubMedGoogle Scholar
  7. 7.
    Ewert P, Berger F, Vogel M et al. (2000) Morphology of perforated atrial septal aneurysm suitable for closure by transcatheter device placement. Heart 84: 327–331PubMedCrossRefGoogle Scholar
  8. 8.
    Ferencz C, Rubin JD, McCarter RJ et al. (1985) Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol 121: 31–36PubMedGoogle Scholar
  9. 9.
    Fisher DC, Fisher EA, Budd JH et al. (1995) The incidence of patent foramen ovale in 1,000 consecutive patients. A contrast transesophageal echocardiography study. Chest 107: 1504–1509PubMedCrossRefGoogle Scholar
  10. 10.
    King TD, Thompson SL, Steiner C, Mills NL (1976) Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. Jama 235: 2506–2509PubMedCrossRefGoogle Scholar
  11. 11.
    Kort HW, Balzer DT, Johnson MC (2001) Resolution of right heart enlargement after closure of secundum atrial septal defect with transcatheter technique. J Am Coll Cardiol 38: 1528–1532PubMedCrossRefGoogle Scholar
  12. 12.
    Krumsdorf U, Ostermayer S, Billinger K et al. (2004) Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol 43: 302–309PubMedCrossRefGoogle Scholar
  13. 13.
    Luxenberg DM, Silvestry FE, Herrmann HC et al. (2005) Use of a new 8 French intracardiac echocardiographic catheter to guide device closure of atrial septal defects and patent foramen ovale in small children and adults: initial clinical experience. J Invasive Cardiol 17: 540–545PubMedGoogle Scholar
  14. 14.
    Mas JL, Arquizan C, Lamy C et al. (2001) Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 345: 1740–1746PubMedCrossRefGoogle Scholar
  15. 15.
    Mellert F, Preusse CJ, Haushofer M et al. (2001) Surgical management of complications caused by transcatheter ASD closure. Thorac Cardiovasc Surg 49: 338–342PubMedCrossRefGoogle Scholar
  16. 16.
    Gemeinsame Leitlinie der Deutschen Gesellschaft für Neurologie (DGN) und der Deutschen Schlaganfallgesellschaft (DSG): Primäre und Sekundäre Prävention der zerebralen Ischiämie. Homepage der Deutschen Gesellschaft für NeurologieGoogle Scholar
  17. 17.
    Oliver JM, Gallego P, Gonzalez A et al. (2002) Predisposing conditions for atrial fibrillation in atrial septal defect with and without operative closure. Am J Cardiol 89: 39–43PubMedCrossRefGoogle Scholar
  18. 18.
    Patel A, Lopez K, Banerjee A et al. (2007) Transcatheter closure of atrial septal defects in adults > or =40 years of age: immediate and follow-up results. J Interv Cardiol 20: 82–88.PubMedCrossRefGoogle Scholar
  19. 19.
    Penther P (1994) Patent foramen ovale: an anatomical study. Apropos of 500 consecutive autopsies. Arch Mal Coeur Vaiss 87: 15–21PubMedGoogle Scholar
  20. 20.
    Schwerzmann M, Nedeltchev K, Meier B (2007) Patent foramen ovale closure: a new therapy for migraine. Catheter Cardiovasc Interv 69: 277–284PubMedCrossRefGoogle Scholar
  21. 21.
    Silversides CK, Siu SC, McLaughlin PR et al. (2004) Symptomatic atrial arrhythmias and transcatheter closure of atrial septal defects in adult patients. Heart 90: 1194–1198PubMedCrossRefGoogle Scholar
  22. 22.
    Slottow TL, Steinberg DH, Waksman R (2007) Overview of the 2007 Food and Drug Administration Circulatory System Devices Panel meeting on patent foramen ovale closure devices. Circulation 116: 677–682PubMedCrossRefGoogle Scholar
  23. 23.
    Vogel M, Berger F, Kramer A et al. (1999) Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defects. Heart 82: 30–33PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Klinik für angeborene Herzfehler/KinderkardiologieDeutsches Herzzentrum BerlinBerlinDeutschland

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