BASIL D. THANOPOULOS MD, PhD Associate Professor Honorary Consultant, RBH, London, UK
|
|
- Bertha O’Connor’
- 6 years ago
- Views:
Transcription
1 TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO BASIL D. THANOPOULOS MD, PhD Associate Professor Honorary Consultant, RBH, London, UK
2 TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO BASIL D. THANOPOULOS MD, PhD Associate Professor Honorary Consultant, RBH, London, UK Proctor Vascular Innovations
3 Transcatheter closure with a device delivered transvenously is currently the procedure of choice for the majority of patients with hemodynamically significant secundum atrial septal defects. Complete closure rate approaches 100% and the results are comparable to those of surgical closure.
4 However even in nowadays several questions come to mind about transcatheter closure of ASDs-namely, What ASDs are not suitable for device closure? Which is the best currently available occluder? Which is the best sizing technique? Guidance of the procedure? How to close large ( 3cm) and Complex ASDs?, What are the risks? Late follow-up?
5
6 TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO ASDs that are not suitable for device closure Large ASDs ( 30 mm) requiring a oversized occluder encroaching the adjacent cardiac structures (e.g. MV, SVC, PVs) ASDs with deficient 1 rim (usually PI <3 mm) + deficient or absent aortic rim ASDs with an echo diameter > 35 mm
7 ASD OCCLUDERS Self-centering 1996 ASO Repositionable No angles-spokes Easy loading-delivery Stenting effect Reusable? 2010 > Implants 100% closure rate % thrombus formation
8 Sizing technique Balloon sizing BSDD BSDD Stop flow
9 Sizing technique
10 Sizing technique
11 GUIDANCE OF THE PROCEDURE Fluoroscopy + 2D-3D TEE IVUS TTE Small-moderate defects (-2cm) with good rims Stand by TEE
12 Large ASDs( 3cm) with or insufficient one rim (3-4 mm)?-
13 LARGE ASDS( 3CM) WITH OR INSUFFICIENT ONE RIM (3-4 MM) Greek maneuver Thanopoulos et al IJC 2013
14 A B C D E F
15 Complex defects Multiple or fenestrated defects ASO,Cribiform A, SF, Helex Insufficient (3-4mm) PI rim Aneurysmal septum
16 *Procedural complications *Similar to those reported by other authors 27% 16% 41% 8% 8% device misplacement transient ST elevetion transient AV block embolization transient atrial arrhytmia
17 REPORTED LATE COMPLICATIONS Major (Rare): Atrial-aortic wall erosion(0.001%) Embolization of the device (0.55%)? Thromboembolism Endocarditis Minor: Mild AV valve regurgitation Atrial arrhythmias Transient migraine Complete AV block
18 REPORTED LATE COMPLICATIONS Atrial-aortic wall erosions EL-Said CCI, 2009 Amin et al,cci 2005 Dinekar et al JACC /12000 (0.001%) 28 cases Deficient AS-rim 24 cases Anatomy of FO 29% Oversized occluder? 13% 68% 72h 1y 5d-8m 4% 4 Deaths? 67% 1,5h-6d un 3w-3y 21%
19 REPORTED LATE COMPLICATIONS Atrial-aortic wall erosions Device position with lower risk for erosion Devices that straddle the aorta somewhat oversized, and which do not move relative to the heart? EL-Said-Moore, CCI, 2009
20 Sarris et al EJCVS 2010
21
22 Thanopoulos et al N = 778 pts Age (years) = 12.8 ± 13.4 Defect diameter (TEE mm) = 15.5 ± 5.5mm Devise diameter (Dx2:24) = 19.3 ± 6.3mm Non attempted or failed procedure=8.6% (64/742). (ASDs > 35 mm, Complex defects: deficient PI rim, Swiss type) Major complications: 3 device embolization 1 catheter retrieved,-2 surgically removed-no device related erosion (423pts-5y FU)
23 ASO ASD OCCLUDERS Occlutech Helex CSO Thanopoulos et al IJC 2014
24 CONCLUSIONS I Transcatheter device closure s is a safe and effective alternative to surgical treatment for the great majority of patients with secundum ASDs. Precise selection of suitable patients, use of a properly sized ASO, careful monitoring of the procedure and closed patient follow-up will significantly reduce the risk of device-related complications
25 CONCLUSIONS II The Cocoon Septal Occluder is an effective and safe double disc ASD occluder that has certain design features which make it potentially attractive for catheter closure of secundum ASDs.
26 TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO PFO AND CRYPTOGENIC STROKE There is still controversy? in the literature regarding the optimal treatment for secondary stroke prevention in patients with cryptogenic stroke (CS) and patent foramen ovale
27 PFO AND CRYPTOGENIC STROKE THROMBUS THROUPH
28 PFO AND CRYPTOGENIC STROKE RISK FACTORS Large RLS (unprovoked shunt) Septal aneurysm General population: 1.2% PFO-CS: 50-89%% De Castro et al Stroke 2000 Mass et al NEJM 2001 Messer et al Neurology 2004 Wohrle et all, Lancet 2006 Eustachian valve? Hypercoagulable state? Pulmonary embolism OR: CS (6.6%)-Death (11.4%) RR:4x Konstadinides el, Circulation 1988
29 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE CATHETER CLOSURE Procedure 1/2 day hospitalization Local-general anaesthesia ΤΕΕ guidance IVE (AcuNav) - Fluoroscopy 8-9F sheath- device size: 18, 25, 35 mm - APFOO Αντιβίωση: 2 δόσεις TTE 1,3 months (ΤΕΕ 6 months)
30 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE GUIDANCE Fluoroscopy Wahl et al JACC 2009 CC: 91% Compl: 0.8% Thanopoulos et al ESC (Abstr) 2009 Echo: CC: 98% Min RS Fluoro: CC: 98% Mod RS(4pts): RCS Catheter closure of PFO using the APFOO can be safely and effectively performed in the majority of the cases without ultrasonic guidance. However, echocardiographically guided PFO closure is associated with lower incidence of residual shunting and recurrent embolic events.
31 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE GUIDANCE Fluoroscopy Wahl et al JACC 2009 CC: 91% Compl: 0.8% Thanopoulos et al ESC (Abstr) 2009 Echo: CC: 98% Min RS Fluoro: CC: 98% Mod RS(4pts): RCS Catheter closure of PFO using the APFOO can be safely and effectively performed in the majority of the cases without ultrasonic guidance. However, echocardiographically guided PFO closure is associated with lower incidence of residual shunting and recurrent embolic events.
32 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE CATHETER V MEDICAL TREATMENT Stroke recurrence under ATT QSS-AAN, Messe et al Neurology 2004 Lausanne study, Bogousslavsky et all, Neurology 1996 French PFO/ASA Study, Mass et al, NEJM 2001 PICSS-RCT, Homma et al, Circulation 2002 AR: % PFO alone does not portend an increased risk for recurrent CS in medically treated patients PFO-SA: HR=4.17/Mass et al NEJM 2001
33 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE CATHETER V MEDICAL TREATMENT Stroke recurrence after PFO closure Most recent studies Windecker et all, JACC 2004 Von Bardeleben et all, IJC 2008 Wohrle et all, Lancet 2006 Cutty et al, AJC 2008 Wahl et all, Heart 2008 Ford et all, JACC-CI 2009 Pineda et all, CCI 2013 Catheter PFO closure may be (is) more beneficial the medical therapy RA:0-3.4% Khan et all, JACC 2013
34 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE PFO AND CRYPTOGENIC STROKE Randomized Control Trials Meier et al N Engl J Med 2013 (PC 404 pts) - NS Carrol et al N Engl J Med 2013 (Respect 980 pts) + Furlan et al N Engl J Med 2013 (909 pts) - NS
35 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE
36 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE PFO AND CRYPTOGENIC STROKE Randomized Control Trials Sample sizes are small ( pts) to give significant statistical differences CLOSURE I NMT 17/6/2010 (SF) Small non statistically significant benefit from device closure Criticism Eligibility criteria too! broad Low shunt free CR (86%)
37 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE PFO AND CRYPTOGENIC STROKE Asymptomatic PFO SPARC Study : Meissner et al JACC 2006 NOMAS Study : Di Tullio et al JACC 2007 Risk of stroke from a PFO in the general population is low
38 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE PFO AND CRYPTOGENIC STROKE Severity of first CS Thanopoulos et al (unpublished data) 17/234 pts (7.2%) 3: Hemianopsia 6: Hemiparesis- 2: Severe MI 3: Severe Brain damage 3: aphasia Al with large RLS and SA
39 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE PFO occluders Amplatzer CS SF Helex Occlutech PFO Star BS Nitocclud PFO Coherex FS
40 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE CATHETER CLOSURE Current guidelines PFO closure may be considered for patients with recurrent cryptogenic stroke despite medical therapy (Class IIb, Level C). AHA/ASA,Sacco et al, Stroke 2006 PFO closure may be considered for high risk patients; ES0, Cerebrovasc Dis 2008 Our institutional guidelines High risk patients > 1 CS, ASA,LRS (Asymptomatic;) Severe hypoxemia Major CS: Pilots, Divers
41 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE CONCLUSIONS I Patent foramen ovale is commonly associated with cryptogenic stroke, particularly in young patients All patients with cryptogenic stroke should have transesophageal echo evaluation with color Doppler and bubble test during Valsava maneuver Meta-analysis, comparative and randomized data suggest that device closure of PFO improves the outcomes compared to medical treatment
42 NOVEL DATA FOR PERCUTANEOUS PFO CLOSURE CONCLUSIONS ΙI Additional indications may be include professional divers, high altitude pilots, the rare cases of platypnea orthodeoxia and patients with indwelling Hickman catheters. Migraine is not yet an indication but it may be in the near future.
TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO
TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT AND PFO BASIL D. THANOPOULOS MD, PhD Associate Professor Agios Loukas Clinic, Thessaloniki, Greece Ares Heart Center, Bucharest, Romania Honorary Consultant,
More informationPFO (Patent Foramen Ovale): Smoking Gun or an Innocent Bystander?
PFO (Patent Foramen Ovale): Smoking Gun or an Innocent Bystander? J Thompson Sullebarger, M.D. Florida Cardiovascular Institute University of South Florida Kris Letang Tedy Bruschi Bret Michaels The Atrial
More informationAntithrombotic Summit Basel 2012 Basel, 26. April Peter T. Buser Klinik Kardiologie Unviersitätsspital Basel
Antithrombotic Summit Basel 2012 Basel, 26. April 2012 Peter T. Buser Klinik Kardiologie Unviersitätsspital Basel Background stroke = third-leading cause of death among adults 1/5 of stroke survivors require
More informationCryptogenic Stroke/PFO with Thrombophilia and VTE: Do We Know What To Do?
Cryptogenic Stroke/PFO with Thrombophilia and VTE: Do We Know What To Do? Robert J. Sommer, MD Columbia University Medical Center New York, NY Disclosure Statement of Financial Interest Within the past
More informationI, (Issam Moussa) DO NOT have a financial interest/arrangement t/ t or affiliation with one or more organizations that could be perceived as a real
PFO Closure: Where We Are Going to after CLOSURE I Study? Issam D. Moussa, MD Professor of Medicine Chair, Division of Cardiovascular Diseases Mayo Clinic Jacksonville, Florida Disclosure Statement of
More information2D/3D in Evaluation of Atrial Septum
2D/3D in Evaluation of Atrial Septum Roberto M Lang, MD OSTIUM SECUNDUM ASD: 2D AND 3D TNSESOPHAGEAL ECHO 1 Biplane views 90 0 3D Acquisi on Acquire 3D volume Lang RM et al. JASE 2012;25:3 46. Right atrial
More informationFabien Praz, Andreas Wahl, Sophie Beney, Stephan Windecker, Heinrich P. Mattle*, Bernhard Meier
Procedural Outcome after Percutaneous Closure of Patent Foramen Ovale using the Amplatzer PFO Occluder Without Intra-Procedural Echocardiography in 1,000 Patients Fabien Praz, Andreas Wahl, Sophie Beney,
More informationIndex. interventional.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Alagille syndrome, pulmonary artery stenosis in, 143 145, 148 149 Amplatz devices for atrial septal defect closure, 42 46 for coronary
More informationAtrial Septal Defect Closure. Stephen Brecker Director, Cardiac Catheterisation Labs
Stephen Brecker Director, Cardiac Catheterisation Labs ADVANCED ANGIOPLASTY Incorporating The Left Main 5 Plus Course Conflicts of Interest The following companies have supported educational courses held
More informationΓεώργιος Δ. Κατσιμαγκλής. Αν. Διευθυντής Καρδιολογικής ΚλινικήςΝΝΑ Διευθυντής Αιμοδυναμικού Εργαστηρίου ΝΝΑ
Γεώργιος Δ. Κατσιμαγκλής Αν. Διευθυντής Καρδιολογικής ΚλινικήςΝΝΑ Διευθυντής Αιμοδυναμικού Εργαστηρίου ΝΝΑ I have no disclosures ΣΥΧΝΟΤΗΤΑ An atrial septal defect (ASD) is a deficiency of the atrial septum.
More informationGlenmark Cardiac Centre Mumbai, India
ASD device closure: Long term follow up Bharat Dalvi, MD Glenmark Cardiac Centre Mumbai, India Our experience 1998 to 2011 1566 patients 912 patients > 4 years FU Exclusive with ASO Clinical, electrocardiographic
More informationPercutaneous VSD closure
Percutaneous VSD closure Gianfranco Butera San Donato Milanese - Italy Patients selection Pts having hemodynamically significant VSD Left ventricular enlargement (left ventricular overload),defined as
More informationPFO- To Close for Comfort. By: Vincent J.Caracciolo, MD FACC
PFO- To Close for Comfort By: Vincent J.Caracciolo, MD FACC PATENT FORAMEN OVALE PFO- congenital lesion that frequently persists into adulthood ( 25-30%)- autopsy and TEE studies. PFO prevalence higher
More informationLONG TERM COMPLICATIONS FOLLOWING PERCUTANEOUS ASD CLOSURE
LONG TERM COMPLICATIONS FOLLOWING PERCUTANEOUS ASD CLOSURE Zakaria Jalal Cardiopathies congénitales de l enfant et de l adulte Hôpital cardiologique Haut Lévêque Pessac CHU Bordeaux INTRODUCTION Percutaneous
More informationΔΙΑΧΕΙΡΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΜΕΣΟΚΟΛΠΙΚΗ ΕΠΙΚΟΙΝΩΝΙΑ ΖΑΧΑΡΑΚΗ ΑΓΓΕΛΙΚΗ ΚΑΡΔΙΟΛΟΓΟΣ ΗΡΑΚΛΕΙΟ - ΚΡΗΤΗ
ΔΙΑΧΕΙΡΙΣΗ ΑΣΘΕΝΩΝ ΜΕ ΜΕΣΟΚΟΛΠΙΚΗ ΕΠΙΚΟΙΝΩΝΙΑ ΖΑΧΑΡΑΚΗ ΑΓΓΕΛΙΚΗ ΚΑΡΔΙΟΛΟΓΟΣ ΗΡΑΚΛΕΙΟ - ΚΡΗΤΗ European Accreditation in TTE, TEE and CHD Echocardiography NOTHING TO DECLARE ATRIAL SEPTAL DEFECT TYPES SECUNDUM
More informationRahul Jhaveri, M.D. The Heart Group of Lancaster General Health
Rahul Jhaveri, M.D. The Heart Group of Lancaster General Health INTRODUCTION Three recently published randomized controlled trials in The New England Journal of Medicine provide new information about closure
More informationWhy Should We Treat PFO?
Why Should We Treat PFO? SCAI Interventional Cardiology Fellows Course December 7, 2012 Jonathan Tobis, MD Director of Interventional Cardiology UCLA Disclosures Jonathan Tobis, MD 1. A Principal Investigator
More informationCONGENITAL HEART DEFECTS IN ADULTS
CONGENITAL HEART DEFECTS IN ADULTS THE ROLE OF CATHETER INTERVENTIONS Mario Carminati CONGENITAL HEART DEFECTS IN ADULTS CHD in natural history CHD with post-surgical sequelae PULMONARY VALVE STENOSIS
More informationDevice Closure of ASD in Children Using the Amplatzer Devices: Indications and catheter preparations, technique, and outcome [15]
Device Closure of ASD in Children Using the Amplatzer Devices: Indications and catheter preparations, technique, and outcome [15] SCAI Fellow Course Fall 2014 Ralf J Holzer MD MSc FSCAI Medical Director
More informationPatent foramen ovale (PFO) is composed of
PFO Closure for Prevention of Recurrent Cryptogenic Stroke The evidence base is here. BY JOHN F. RHODES, JR, MD Patent foramen ovale (PFO) is composed of overlapping portions of septum primum and septum
More informationPFO Management update
PFO Management update May 12, 2017 Peter Casterella, MD Swedish Heart and Vascular 1 PFO Update 2017: Objectives Review recently released late outcomes of RESPECT trial and subsequent FDA approval of PFO
More informationPatent Foramen Ovale Closure Without Echocardiographic Control: Use of Standby Intracardiac Ultrasound
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 1, NO. 4, 2008 2008 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/08/$34.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2008.05.006 Patent Foramen
More informationFermeture percutanée des CIA : matériels disponibles et résultats. Transcatheter closure of ASD : devices and results
Fermeture percutanée des CIA : matériels disponibles et résultats Transcatheter closure of ASD : devices and results François Godart, University of Lille 2, France 12 e Congrès Médico-Chirurgical de la
More informationINSTRUCTIONS FOR USE FOR:
INSTRUCTIONS FOR USE FOR: en English bg INSTRUCTIONS FOR USE FOR: GORE CARDIOFORM SEPTAL OCCLUDER Carefully read all instructions prior to use. Observe all warnings and precautions noted throughout these
More informationDescription. Page: 1 of 23. Closure Devices for Patent Foramen Ovale and Atrial Septal Defects. Last Review Status/Date: December 2014
Last Review Status/Date: December 2014 Page: 1 of 23 Description Background Patent Foramen Ovale The foramen ovale, a component of fetal cardiovascular circulation, consists of a communication between
More informationType Size AP/PS RP/RS Qp/Qs. Ia Resistive <0.3 < Ib Resistive <0.3 < IIa Resistive <0.5 >2
Transcatheter closure of VSD using Duct Occluder device Nguyen Lan Hieu, MD, PhD Hanoi Medical University Vietnam Heart Institute Anatomy of VSD 1. Perimembranous VSD: Aneurysm septal membranous(tv or
More informationHybrid Muscular VSD Closure in Small Weight Children
Hybrid Muscular VSD Closure in Small Weight Children Shakeel A Qureshi, on behalf of: John P. Cheatham, MD George H. Dunlap Endowed Chair in Interventional Cardiology Director Cardiac Catheterization &
More informationPercutaneous closure of a patent foramen ovale after cryptogenic stroke
Neth Heart J (2018) 26:5 12 https://doi.org/10.1007/s12471-017-1063-3 POINT OF VIEW Percutaneous closure of a patent foramen ovale after cryptogenic stroke R. J. R. Snijder 1 M.J.Suttorp 1 J.M.tenBerg
More informationTranscatheter closure of patent foramen ovale using the internal jugular venous approach
New methods in diagnosis and therapy Transcatheter closure of patent foramen ovale using the internal jugular venous approach Przemysław Węglarz 1,2, Ewa Konarska-Kuszewska 2, Tadeusz Zębik 2, Piotr Kuszewski
More informationAtrial septal defects (ASDs) are one of the most
Transcatheter Closure of Atrial Septal Defects An update on ASD occlusion devices. BY VICTOR-XAVIER TADROS, MD, MSc, AND ANITA W. ASGAR, MD, FRCPC, FACC Atrial septal defects (ASDs) are one of the most
More informationCPAG Summary Report for Clinical Panel Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke
MANAGEMENT IN CONFIDENCE CPAG Summary Report for Clinical Panel Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke The Benefits of the Proposition Percutaneous Patent Foramen Ovale
More informationPatent Foramen Ovale: Diagnosis and Treatment
Patent Foramen Ovale: Diagnosis and Treatment Anthony DeMaria Judy and Jack White Chair in Cardiology University of California, San Diego At one time or another a Grantee, Sponsored Speaker or Ad-hoc Consultant
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute ischemic stroke TOAST classification of, 270 Acute myocardial infarction (AMI) cardioembolic stroke following, 207 208 noncardioembolic
More informationRESPECT Safety Findings
CO-1 SCAI Town Hall Meeting Monday, October 31, 2016 Washington, DC RESPECT Safety Findings John D. Carroll, M.D., MSCAI Professor of Medicine Cardiology University of Colorado School of Medicine University
More informationStroke and ASA / FO REBUTTAL
REBUTTAL Definition of an ischemic stroke Definition of a PFO Evidence for a causal role of PFO in stroke Evidence against a role of PFO in stroke Stroke recurrencies in stroke (PFO) patients Medical treatment
More informationPERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE AND ATRIAL SEPTAL DEFECT: STATE OF THE ART AND A CRITICAL APPRAISAL
PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE AND ATRIAL SEPTAL DEFECT: STATE OF THE ART AND A CRITICAL APPRAISAL Carmelo Cernigliaro Clinica San Gaudenzio Novara Eco 2D e 3D Eco Transesofageo Large shunt
More informationTranscatheter Closure of Septal Defects
Transcatheter Closure of Septal Defects Policy Number: 2.02.09 Last Review: 11/2018 Origination: 3/2007 Next Review: 11/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage
More informationInterventions in Adult Congenital Heart Disease: Role of CV Imaging. Associate Professor. ACHD mortality. Pillutla. Am Heart J 2009;158:874-9
Interventions in Adult Congenital Heart Disease: Role of CV Imaging Sangeeta Shah MD, FACC, FASE Associate Professor ACHD mortality Pillutla. Am Heart J 2009;158:874-9 Adult Congenital Heart Disease Heterogenity
More information2017 Cardiovascular Symposium CRYPTOGENIC STROKE: A CARDIOVASCULAR PERSPECTIVE DR. WILLIAM DIXON AND DR. VENKATA BAVAKATI SOUTHERN MEDICAL GROUP, P.A.
CRYPTOGENIC STROKE: 2017 Cardiovascular Symposium A CARDIOVASCULAR PERSPECTIVE DR. WILLIAM DIXON AND DR. VENKATA BAVAKATI SOUTHERN MEDICAL GROUP, P.A. CRYPTOGENIC STROKE CRYPTOGENIC: OF OBSCURE OR UNKNOWN
More informationCorporate Medical Policy
Corporate Medical Policy Congenital Heart Defect, Repair Devices File Name: Origination: Last CAP Review: Next CAP Review: Last Review: congenital_heart_defect_repair_devices 10/2000 6/2017 6/2018 6/2017
More informationDEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE. Matthew Starr, MD Stroke Attending
DEBATE: PFO MANAGEMENT TO CLOSE OR NOT TO CLOSE Matthew Starr, MD Stroke Attending DISCLOSURES None DEBATE Should PFO be closed? * * Sometimes yes THE CASE AGAINST PFO CLOSURE 1. Did the PFO cause the
More informationIntracardiac echocardiography: an ideal guiding tool for device closure of interatrial communications
Eur J Echocardiography (2005) 6, 92e96 Intracardiac echocardiography: an ideal guiding tool for device closure of interatrial communications Thomas Bartel a, *, Thomas Konorza a, Ulrich Neudorf b, Tiko
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of percutaneous closure of patent foramen ovale for the secondary prevention
More informationThe earliest application of intracardiac imaging
Intracardiac Echocardiography for Structural Heart Defects A review of ICE innovations, devices, and techniques. BY ZAHID AMIN, MD; QI-LING CAO, MD; AND ZIYAD M. HIJAZI, MD The earliest application of
More informationThe ABCs of PFOs and ASDs. John M. Lasala MD PhD Director of Adult Structural Heart Disease Washington University
The ABCs of PFOs and ASDs John M. Lasala MD PhD Director of Adult Structural Heart Disease Washington University Disclosure Consultant, Proctor AGA /St. Jude Medical The PFO / Stroke Story >2,400 yrs-ago
More informationTranscatheter Closure of Septal Defects
Transcatheter Closure of Septal Defects Policy Number: 2.02.09 Last Review: 11/2017 Origination: 3/2007 Next Review: 11/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage
More informationThe Patent Foramen Ovale A Preventable Stroke Etiology?! Brian Whisenant, M.D.
The Patent Foramen Ovale A Preventable Stroke Etiology?! Brian Whisenant, M.D. Conflict of Interest Statement I have a financial interest in Coherex Medical. Heart Disease and Stroke Statistics 2008 Update:
More informationGERIATRICS CASE PRESENTATION
GERIATRICS CASE PRESENTATION CASE 79 year old Patient X was admitted to hospital with SOB. He had a hx of sarcoidosis and asbestosis. Home oxygen requirement is 3-3.5litre. He was admitted, given ceftriaxone
More informationCryptogenic Stroke: What Don t We Know. Siddharth Sehgal, MD Medical Director, TMH Stroke Center Tallahassee Memorial Healthcare
Cryptogenic Stroke: What Don t We Know Siddharth Sehgal, MD Medical Director, TMH Stroke Center Tallahassee Memorial Healthcare Financial Disclosures None Objectives Principles of diagnostic evaluation
More informationUpdate interventional Cardiology Hans Rickli St.Gallen
Update interventional Cardiology 2012 Hans Rickli St.Gallen 26.11.2012 Review of Literature ESC-Highlights TCT/AHA-Highlights Update interventional cardiology 2012 Structural Heart Disease Transcatheter
More informationDevices for Stroke Prevention. Douglas Ebersole, MD Interventional Cardiology Watson Clinic LLP
Devices for Stroke Prevention Douglas Ebersole, MD Interventional Cardiology Watson Clinic LLP Overview Left Atrial Appendage Closure FDA Approved Watchman Investigational Amulet PFO Closure Atrial Fibrillation
More informationSuccessful Percutaneous Closure of Mitral Bioprosthetic Paravalvular Leak Using Figulla ASD Occluder
Hans R. Figulla, M.D., PhD ; Ali Hamadanchi, M.D. Medicine, Pneumology Universitity Hospital, Jena, Germany Successful Percutaneous Closure of Mitral Bioprosthetic Paravalvular Leak Using Figulla ASD Occluder
More informationCLOSE. Closure of Patent Foramen Ovale, Oral anticoagulants or Antiplatelet Therapy to Prevent Stroke Recurrence
CLOSE Closure of Patent Foramen Ovale, Oral anticoagulants or Antiplatelet Therapy to Prevent Stroke Recurrence Guillaume TURC, MD, PhD Paris Descartes University Sainte-Anne hospital Paris, France On
More informationINTEGRATING ECHOCARDIOGRAPHY WITH CATHETER INTERVENTIONS FOR CONGENITAL HEART DISEASE. Krishna Kumar SevenHills Hospital, Mumbai, India
INTEGRATING ECHOCARDIOGRAPHY WITH CATHETER INTERVENTIONS FOR CONGENITAL HEART DISEASE Krishna Kumar SevenHills Hospital, Mumbai, India Why talk about it? What is the big deal? Are we not stating the obvious?
More informationPatent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS
Patent Foramen Ovale and Cryptogenic Stroke: Do We Finally Have Closure? Christopher Streib, MD, MS 11-8-18 Outline 1. Background 2. Anatomy of patent foramen ovale (PFO) 3. Relationship between PFO and
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,500 108,000 1.7 M Open access books available International authors and editors Downloads Our
More informationEchocardiographic Guidance During Placement of the Buttoned Double-Disk Device for Atrial Septa1 Defect Closure
Echocardiographic Guidance During Placement of the Buttoned Double-Disk Device for Atrial Septa1 Defect Closure L. LUANN MINICH, M.D., and A. REBECCA SNIDER, M.D. Department of Pediatrics, C.S. Mott Children
More informationWhy Treat Patent Forman Ovale
Why Treat Patent Forman Ovale Clifford J Kavinsky, MD, PHD Professor of Medicine and pediatrics Associate Director, Center for Congenital and Structural Heart Disease Rush University Medical Center Conclusions
More informationClinical Policy: Transcatheter Closure of Patent Foramen Ovale Reference Number: CP.MP.151
Clinical Policy: Reference Number: CP.MP.151 Effective Date: 12/17 Last Review Date: 12/17 See Important Reminder at the end of this policy for important regulatory and legal information. Coding Implications
More informationPercutaneous ASD closure
S. Hascoët Cardiologie pédiatrique et congénitale Hôpital Marie lannelongue Percutaneous ASD closure Marie Lannelongue Hospital long-term follow-up Groupe de travail sur le cathétérisme Cardiaque et congénital
More informationPFO Closure for the Management of Migraine and Stroke
PFO Closure for the Management of Migraine and Stroke Sun U. Kwon Department of Neurology, Asan Medical Center, UUMC Contents PFO & Migraine PFO causes Migraine or Not? PFO closure for Migraine PFO & Stroke
More informationEAE RECOMMENDATIONS FOR TRANSESOPHAGEAL ECHO. Cardiac Sources of Embolism. Luigi P. Badano, MD, FESC
EAE RECOMMENDATIONS FOR TRANSESOPHAGEAL ECHO. Cardiac Sources of Embolism Luigi P. Badano, MD, FESC Background Stroke is the 3 cause of death in several industrial countries; Embolism accounts for 15-30%
More informationPerventricular Closure of Muscular VSD
Perventricular Closure of Muscular VSD John P. Cheatham, MD, MSCAI George H. Dunlap Endowed Chair in Interventional Cardiology Co-Director, The Heart Center, Nationwide Children s Hospital Professor, Pediatrics
More informationΣΥΓΚΛΕΙΣΗ ΑΝΟΙΚΤΟΥ ΩΟΕΙΔΟΥΣ ΤΡΗΜΑΤΟΣ ΠΕΣΡΟ. ΔΑΡΔΑ, MD, FESC 33 Ο Πανελλήνιο Καρδιολογικό Συνζδριο ΑΘΗΝΑ 2012
ΣΥΓΚΛΕΙΣΗ ΑΝΟΙΚΤΟΥ ΩΟΕΙΔΟΥΣ ΤΡΗΜΑΤΟΣ 2012 ΠΕΣΡΟ. ΔΑΡΔΑ, MD, FESC 33 Ο Πανελλήνιο Καρδιολογικό Συνζδριο ΑΘΗΝΑ 2012 The Problem: Not All PFO in Patients With Cryptogenic Stroke is Pathogenic; No Definitive
More informationAnaesthesia for percutaneous closure of atrial septal defects Patrick A Calvert BCh MA MRCP Andrew A Klein MBBS FRCA
Anaesthesia for percutaneous closure of atrial septal defects Patrick A Calvert BCh MA MRCP Andrew A Klein MBBS FRCA Key points Percutaneous closure is the procedure of choice for the majority of patients
More informationCongenital heart disease. By Dr Saima Ali Professor of pediatrics
Congenital heart disease By Dr Saima Ali Professor of pediatrics What is the most striking clinical finding in this child? Learning objectives By the end of this lecture, final year student should be able
More informationDiversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia
Marshall University Marshall Digital Scholar Internal Medicine Faculty Research Spring 5-2004 Diversion of the inferior vena cava following repair of atrial septal defect causing hypoxemia Ellen A. Thompson
More informationPATENT FORAMEN OVALE: UPDATE IN MANAGEMENT OF RECURRENT STROKE KATRINE ZHIROFF, MD, FACC, FSCAI LOS ANGELES CARDIOLOGY ASSOCIATES
PATENT FORAMEN OVALE: UPDATE IN MANAGEMENT OF RECURRENT STROKE KATRINE ZHIROFF, MD, FACC, FSCAI LOS ANGELES CARDIOLOGY ASSOCIATES OBJECTIVES Review social burden and epidemiology of stroke Gender disparities
More informationMigraine and Patent Foramen Ovale (PFO)
Migraine and Patent Foramen Ovale (PFO) Hans-Christoph Diener Senior Professor of Clinical Neurosciences Department of Neurology and Headache Center University Essen Topics Prevalence of PFO Is migraine
More informationATRIAL SEPTAL CLOSURE AND LEFT ATRIAL APPENDAGE OCCLUSION: INDICATIONS AND GUIDANCE ECHOCARDIOGRAPHY IN INTERVENTIONAL CARDIOLOGY
ATRIAL SEPTAL CLOSURE AND LEFT ATRIAL APPENDAGE OCCLUSION: INDICATIONS AND GUIDANCE Aristides G. Panlilio, MD, FPCP, FPCC,FPSE, FASE Philippine Heart Center Chinese General Hospital and Medical Center
More informationCurrent management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale
Review Article Current management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale Kaivan Vaidya 1,2, Chinmay Khandkar 1,2, David Celermajer 1,2 1 Department of Cardiology,
More informationHow to manage device embolization?
How to manage device embolization? Swiss Fellow Course Interventional Cardiology Amir-Ali Fassa Hôpital de La Tour Meyrin, Geneva Coronary interventions: Definitions Stent loss: stent dislodgment from
More informationTrue cryptogenic stroke
True cryptogenic stroke Arne Lindgren, MD, PhD Dept of Clinical Sciences Lund, Neurology, Lund University Dept of Neurology and Rehabilitation Medicine Skåne University Hospital Lund, Sweden Disclosures
More informationClinical Commissioning Policy Statement: Patent Foramen Ovale (PFO) Closure. April Reference: NHSCB/A09/PS/a
Clinical Commissioning Policy Statement: Patent Foramen Ovale (PFO) Closure April 2013 Reference: NHSCB/A09/PS/a NHS Commissioning Board Clinical Commissioning Policy Statement: Patent Foramen Ovale (PFO)
More informationEpisodic Desaturation
Episodic Desaturation James D. Flaherty, MD Assistant Professor of Medicine University, Feinberg School of Medicine Medical Director, Coronary Care Unit Memorial Hospital, Chicago April 27, 2012 Disclosures
More informationAMPLATZER Septal Occluder Structural Heart Therapy. Over 15 years of. Demonstrated. Clinical Experience. We ll show you our data. Ask to see theirs.
AMPLATZER Septal Occluder Structural Heart Therapy Over 15 years of Demonstrated Clinical Experience We ll show you our data. Ask to see theirs. Leading the Standard of Care 1,2 The AMPLATZER Septal Occluder
More informationIn 1877, Cohnheim performed a
CLINICIAN UPDATE Contemporary Management of Patent Foramen Ovale Bernhard Meier, MD; James E. Lock, MD In 1877, Cohnheim performed a necropsy on a young woman who had died from a stroke. He hypothesized
More informationPractice Parameter: Recurrent Stroke With Patent Foramen Ovale and Atrial Septal Aneurysm
Practice Parameter: Recurrent Stroke With Patent Foramen Ovale and Atrial Septal Aneurysm Report of the Quality Standards Subcommittee of the American Academy of Neurology* S.R. Messé, MD; I.E. Silverman,
More informationUptofate Study Summary
CONGENITAL HEART DISEASE Uptofate Study Summary Acyanotic Atrial septal defect Ventricular septal defect Patent foramen ovale Patent ductus arteriosus Aortic coartation Pulmonary stenosis Cyanotic Tetralogy
More informationAtrial Septal Defects
Supplementary ACHD Echo Acquisition Protocol for Atrial Septal Defects The following protocol for echo in adult patients with atrial septal defects (ASDs) is a guide for performing a comprehensive assessment
More informationTranscatheter Closure of Cardiovascular Defects
Medical Coverage Policy Effective Date...11/15/2017 Next Review Date...11/15/2018 Coverage Policy Number... 0011 Transcatheter Closure of Cardiovascular Defects Table of Contents Related Coverage Resources
More informationClosing ASDs with pulmonary hypertension. Shakeel A Qureshi Evelina Children s Hospital London
Closing ASDs with pulmonary hypertension Shakeel A Qureshi Evelina Children s Hospital London Ho Chi Minh, Vietnam, January 2012 ACC/AHA 2008 Guidelines ASD closure Closure is indicated for right atrial
More informationΔιαδερμική θεραπεία των παραβαλβιδικών διαφυγών Σ.Ράμμος
ΔΜΙΝΑΡΙΟ ΔΠΙΣΗΜΟΝΙΚΩΝ ΔΝΩΔΩΝ ΔΛΛΗΝΙΚΟΤ ΚΟΛΛΔΓΙΟΤ ΚΑΡ ΙΟΛΟΓΙΑ 2-4.10.2015 Δπιζηημονική Ένωζη Δπεμβαηικής Καρδιολογίας Βαλβιδοπάθειες, Γιαδερμικές παρεμβάζεις Διαδερμική θεραπεία των παραβαλβιδικών διαφυγών
More informationFollow-up after VSD closure- what to look for?
The 3rd Congress of Congenital heart disease Ventricular Septal Defect from A-Z January 9-11. 2013, Ho Chi Minh City, Vietnam Follow-up after VSD closure- what to look for? Nina Wunderlich University Hospital
More informationPathology of Atrial Septal Defects. To Close or not to Close?: Atrial Septal Defects are NOT That Simple-Sometimes
Scientific Program Thursday, June 7, 2007 09:00 19:00 Registration 09:00 10:00 Breakfast at the Congress Center 10:00 10:05 Opening Remarks H. Sievert 10:05 10:15 Follow-up of the Patients 2006 C. Heinisch
More informationImplantation of Cardioverter Defibrillator After Percutaneous Closure of Atrial Septal Defect
The Ochsner Journal 10:27 31, 2010 f Academic Division of Ochsner Clinic Foundation Implantation of Cardioverter Defibrillator After Percutaneous Closure of Atrial Septal Defect Anas Bitar, MD, Maria Malaya
More informationMultidetector computed tomography in the evaluation of atrial septal defects
Multidetector computed tomography in the evaluation of atrial septal defects Poster No.: C-0502 Congress: ECR 2010 Type: Educational Exhibit Topic: Cardiac Authors: S. Espejo, R. Ysamat, B. Cajal, M. Pan,
More informationTranscatheter closure of atrial septal defects with transthoracic echocardiography
Cardiology in the Young (2011), 21, 204 208 doi:10.1017/s1047951110001782 r Cambridge University Press, 2010 Original Article Transcatheter closure of atrial septal defects with transthoracic echocardiography
More informationAntithrombotic therapy for patients with congenital heart disease. George Giannakoulas, MD, PhD AHEPA University Hospital Thessaloniki
Antithrombotic therapy for patients with congenital heart disease George Giannakoulas, MD, PhD AHEPA University Hospital Thessaloniki Disclosures Educational fees from Astra Zeneca, GSK Research fees from
More informationComparison Between the New Gore Septal and Amplatzer Devices For Transcatheter Closure of Patent Foramen Ovale
2922 MUSTO C et al. Circulation Journal ORIGINAL ARTICLE Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp Cardiovascular Intervention Comparison Between the New Gore Septal
More informationMultifenestrated Septal Occluder Cribriform
Multifenestrated Septal Occluder Cribriform Instructions for Use Device Description The AMPLATZER Multifenestrated Septal Occluder Cribriform (Cribriform Occluder) is a self-expanding double-disc nitinol
More informationA case report: Percutaneous transcatheter treatment of Lutembacher syndrome
A case report: Percutaneous transcatheter treatment of Lutembacher syndrome Dr. Sainath Hegde* Dr. Tukaram Aute** *Registrar, Dept of Cardiology, M.G.M Hospital, Aurangabad. **Asst. Prof, Dept of Cardiology,
More informationTranscatheter closure of the patent ductus arteriosus using the new Amplatzer duct occluder: Initial clinical applications in children
Transcatheter closure of the patent ductus arteriosus using the new Amplatzer duct occluder: Initial clinical applications in children Basil Thanopoulos, MD, PhD, a Nikolaos Eleftherakis, MD, a Konstantinos
More informationPercutaneous atrial septal defect closure with the Occlutech Figulla Flex ASD Occluder.
Percutaneous atrial septal defect closure with the Occlutech Figulla Flex ASD Occluder. First case with a novel delivery system. Werner Budts, Md, PhD, FESC Congenital and Structural Cardiology University
More informationSurgical Approach To An Unsuccessful Device Closure of Atrial Septal Defect. U Yetkin, B Özpak,? Yürekli, K Ergüne?, N Eren, O Ergene, A Gürbüz
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 11 Number 2 Surgical Approach To An Unsuccessful Device Closure of Atrial Septal Defect U Yetkin, B Özpak,? Yürekli, K Ergüne?,
More informationCIPG Transcatheter Aortic Valve Replacement- When Is Less, More?
CIPG 2013 Transcatheter Aortic Valve Replacement- When Is Less, More? James D. Rossen, M.D. Professor of Medicine and Neurosurgery Director, Cardiac Catheterization Laboratory and Interventional Cardiology
More informationValvular Heart Disease and Adult Congenital Intervention. A Pichard, MD. Director Cath Labs, Washington Hospital Center. Georgetown University.
Valvular Heart Disease and Adult Congenital Intervention. A Pichard, MD Director Cath Labs, Washington Hospital Center. ProfessorofMedicine (Cardiology), Georgetown University. Conflict of Interest Proctor
More informationTranscatheter Closure of Patent Foramen Ovale in Patients With Cerebral Ischemia
Journal of the American College of Cardiology Vol. 39, No. 12, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)01904-6
More informationContemporary echocardiographic guiding tools for device closure of interatrial communications
Review Article Contemporary echocardiographic guiding tools for device closure of interatrial communications Thomas Bartel, Silvana Müller Department of Medicine, Cardiology Division (Cardiology), Innsbruck
More information