Septal Closure Devices

Atrial Septal Defect (ASD)

A congenital deficiency of the interatrial septum leading to an open communication between the right atrium (RA) and left atrium (LA).

Patent Foramen Ovale (PFO) is created by the

Oval fossa

Direction of shunt for fetal circulation

R>L

What is the name of the hole that allows blood to pass between the atrias before birth

Oval fossa

Describe a ostium secundum ASD

gap in the middle, inadequate formation of the septum secundum so that it doesnt completely cover the ostium secundum

Most common type of ASD

Ostium Secundum

Where is the whole in ostium primum

ASD that occurs near the bottom part of the septum, close to valves

Identify each of these ASD

Describe Sinus Venosus and where it is located

A rare type of ASD located near the entrance of the superior vena cava into the right atrium. RARELY at entry of the IVC into RA

When theres a hole in the septum it disrupts the system in 3 main ways

disrupts the pressure gradient from L (02) to R (<02)

Overload the right

mix oxygenated and deoxygenated blood

Coronary Sinus Defect

Another rare type, involving the vein that drains the hearts blood

What occurs in a Left-to-Right Shunt and why is it bad

A condition where blood flows from the left atrium to the right atrium, leading to volume overload of the right heart.

Amplatzer Septal Occluder is made of

A device used for the percutaneous closure of ASDs, made of a nitinol wire mesh with polyester fabric.

What is special about Gore HELEX Septal Occluder

A device designed for ASD closure that features independent discs and petals for better conformability.

Complications of ASD Closure any 2

persistent dysrhythmia or potential lethal intraprocedural arrhythmia requiring cardioversion

death

cardiac or respiratory arrest

device erosion

device embolization

2 most common signs of right sided heart failure

peripheral edema

pedal edema

common symptoms of a large symptomatic ASD

right sided heart failure

pulmonary HTN

^ CO

fluid build up

What is eisenmenger syndrome and why is it a contraindication for a ASD closure

L 2 R shunt reverse to R 2 L due to prolonged pressure overload. closing ASD could worsen p’s condition by trapping the blood flow and ^ pressure in the lungs

what does TEE and TTE stand for

Transesophageal Echocardiography

Transthoracic echocardiography

Which has higher quality image

TEE

or

TTE

TEE

what does ICE stand for

Intra-cardiac echocardiography

Key indication for PFO closure

cryptogenic stroke, stroke prevention RESPECT, REDUCE, CLOSE, and DEFENSE-PFO trials show reduced risk of recurrent stroke in these pt’s

key indication for ASD closure

Significant left to right shunt

significant RH enlargement due to volume overload

R2L shunt causing hypoxemia & or embolism

secundum defect greater than 5mm

Contraindications for ASD closure

small defect

no RV volume overload

describe the anatomy of a PFO

tunnel like passageway between the septum primum and septum secundum

describe the anatomy of a ASD

hole in the atrial septum caused by congenital failure in overlap between the septum primum and secundum

Name these devices

name these devices

which is the ASD

which is the PFO device

pfo or ASD?

asd

What side is this disc supposed to go on

What device is this

Amplatz septal occluder

What device is this

Gore HELEX Septal Occluder

What device is this