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ASD Closure in Special Situations: Elderly, PA-IVS

  • Giuseppe Santoro
  • Mario Giordano
  • Maria Teresa Palladino
  • Carola Iacono
  • Gianpiero Gaio
  • Marco Di Maio
  • Berardo Sarubbi
  • Maria Giovanna Russo
Chapter

Abstract

Transcatheter closure is nowadays considered as the first-choice treatment of atrial septal defect (ASD). However, indication, technique, and results of this approach are still challenging and under debate in particular settings, as in elderly or in patients with pulmonary atresia with intact ventricular septum (PA-IVS) submitted to right ventricular decompression.

Supplementary material

Video 1

Temporary ASD balloon occlusion in elderly patient to size the defect as well as to evaluate any hemodynamic change resulting from the sudden left-to-right shunt disappearance. The occluding balloon is inflated into the right atrium and carefully advanced to the atrial septum until the shunt disappears, as evaluated at color Doppler analysis (MP4 4507 kb)

Video 2

Step-by-step description of percutaneous ASD closure as imaged at fluoroscopy. After ASD sizing, the left disk and the central waist of the device are sequentially opened in the left atrium and carefully approached to the atrial septum. As soon as the central waist fills the atrial septal defect, the right disk of the device is deployed in order to stabilize the device. Then, a “push and pull” maneuver is performed to test the device stability. Finally, the device is released (MP4 14243 kb)

Video 3

Bidirectional shunt at atrial level in a patient with PA-IVS previously submitted to RV decompression by pulmonary valve perforation and angioplasty, as imaged at TEE color Doppler analysis (MP4 4664 kb)

Video 4

Step-by-step description of percutaneous ASD closure, as imaged at TEE. After ASD sizing, the left disk and the central waist of the device are sequentially opened in the left atrium and carefully approached to the atrial septum. As soon as the central waist fills the atrial septal defect, the right disk of the device is deployed in order to stabilize the device. Then, a “push and pull” maneuver is performed to test the device stability. Finally, the device is released and any residual shunt is imaged by color Doppler analysis (MP4 6051 kb)

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Giuseppe Santoro
    • 1
  • Mario Giordano
    • 2
  • Maria Teresa Palladino
    • 2
  • Carola Iacono
    • 2
  • Gianpiero Gaio
    • 2
  • Marco Di Maio
    • 2
  • Berardo Sarubbi
    • 2
  • Maria Giovanna Russo
    • 2
  1. 1.Paediatric Cardiology and GUCH Unit, Fondazione Toscana-CNR “G. Monasterio”MassaItaly
  2. 2.Paediatric Cardiology and GUCH Unit, A.O.R.N. “Ospedali dei Colli”II University of NaplesNaplesItaly

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