This document summarizes a presentation on transcatheter closure of an atrial septal defect (ASD). A 65-year-old female patient presented with shortness of breath and occasional palpitations. Testing revealed a 14mm ASD with left-to-right shunting and right ventricular dilation. The patient underwent a successful transcatheter closure of the ASD using an 22mm Amplatzer device. The presentation covered recommendations for when closure is indicated based on defect size and shunt ratio, advantages of device closure over surgery, potential complications, and follow-up care after the procedure.

1. Presented by: Dr. Ibdah

2.  65 year old patient ,female
 c/o : SOB, occasional palpitations
 TEE: ASD II , Left to Right Shunt. Diameter of
defect 14 mm . RV dilated with signs of volume
overloading
 Right heart Catheterization: PA sys 36mmHg
PVR 61 dyn/cm5
 Balloon sizing :

4.  successful transcatheter ASD closure with
Amplazer device 22mm

5.  Common 3-10% of CHD
 Classification: ASD I, ASD II 70%, sinus venosus
 Female > Male
 Pathophsiology : initially left to right shunt
 Clinical features and diagnostic evaluation:
are not the scope of this presentation!

6.  Three questions crystallize the debate :
1. Who should have their ASD closed?
2. When should it be closed?
3. How should it be closed?

7.  Any patient with dilated RV or RA by Echo,MRT
or CT
 any ASD ( in the absence of of advanced
pulmonary HTN) with one or more of following:
1. ASD > 10 mm on TEE
2. Qp:Qs > 1.5:1

8.  Yes close it and yes do it as soon as possible !
 Is the age matter ? The answer is NO

9.  The defect too small follow them periodically
 Severe pulmonary arterial HTN ; do not close !
ASD acts here as ``pop-off`` valve
 Pregnancy  defer 6 months after delivery
 Severe LV dysfunction . Again ASD functioning
as`` pop-off`` valve

11.  Device closure is a safe and effective procedure in
experienced hands
 Advantages of device closure :
less hospital stay, avoidance surgical wounds, same
hemodynamic benefit as by surgery
 Drawbacks: large defect > 36 mm, septal rim less
than 5 mm, proximity of defect to AV ,CS,IVC,SVC

12. Successful closure achieved in 95 % of Pt.
 Tachyarrhythmia 1-4% follow up , ablation
 Brady arrhythmia  Pacing
 Device migration and erosion : catastrophic but rare
0,1 %related to operator experience and over sizing
 Right heart failure or progressive pulmonary HTN ;
related to the age of patient at the time of closure
 Thrombosis 1.2 %: maximal at 4 weeks ,rare with
dual therapy era
 Nickel allergy ! Chest pain at next day  do skin test
if positive  remove the device

13.  Small: common after catheter closure ,close
spontaneously after 1 year
 Large : false measurement, dehisced
ASD device

14.  Dual antiplatelet therapy 6 months
 TTE next day .
 TEE in 1,6 and in 12 months
 IE-prophylaxis for 6 months

15.  Majority of ASD II are device closable
 Safe and effective procedure
 need for excellent pre-procedure work up

16. Thank you for your attention