Atrial Septal Defect

Transcription

1 S. Hascoët Cardiologie pédiatrique et congénitale Hôpital Marie lannelongue Atrial Septal Defect long-term follow-up after closure Groupe de travail sur le cathétérisme Cardiaque et congénital

2 Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : none

3 Natural History Atrial arrhythmias (AF 50% at 60 yo) Pulmonary Hypertension Paradoxical embolism Right heart failure Lower life expectancy Closure during childhood or at diagnosis

4 Sinus Venosus Defect Ostium Secundum Defect

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6 1 st procedure : King and Mills 1974 Amplatz 1997 FDA approval 2001

7 Complex ASD

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9 Long-Term Follow-Up of Large Atrial Septal Occluder (Amplatzer Device) With Cardiac MRI in a Pediatric Population Chantale Lapierre, Nicolas Hugues, Nagib Dahdah, Julie Déry, Marie-Josée Raboisson, Joaquim Miró 122 patients from AJR 2012; 199: Highest quartile for device size 25 participants MRI in 2002 and 2009

10 Long-Term Follow-Up of Large Atrial Septal Occluder (Amplatzer Device) With Cardiac MRI in a Pediatric Population Chantale Lapierre, Nicolas Hugues, Nagib Dahdah, Julie Déry, Marie-Josée Raboisson, Joaquim Miró AJR 2012; 199: : 8 yrs 2009: 15 yrs

11 Percutaneous ASD Excellent short-term results Feasibility > 96% patients in 203 studies Mortality 0,01% Abaci Cath. Cardiovasc. Inter 2013 Less morbidity than surgery => 1 ère option Butera, Eurointervention 2011 Du, JACC 2002

12 Quebec JACC CI 2013

13 18 Dec 2012: Amplatzer SO 40 mm 13 Oct 2013 : Chicago s Marathon

14 Atrial Septal Defect long-term follow-up after closure? Is there a need for a follow-up after closure? «le meilleur synonyme de la guérison, c est l oubli» Dr J. Petit, Marie Lannelongue

15 Residual lesions ASD close 10 y before

16 Post operative lesions 44 y. o. Headache SV surgery Sinusal dysfunction

17 Extremely rare but serious potential adverse events Cardiac Perforation After Percutaneous Closure of an ASD % Mortalité 0,05% vs 1-3% with surg Marta Ruiz Leraa, Rev Esp Cardiol. 2007

18 Late endocarditis on ASD device Slesnick, circulation 2008 Late endocarditis on ASD device 3 years after the procedure. Courtesy to Pascal Amedro

19 Late AVB Cheatham Pediatr. Cardiol Acute thrombosis Late thrombosis 3 years after closure Olabiyi pediatr. Cardiol. 2013

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22 Hôpital Marie Lannelongue Major Unexpected Events: 1743 (end of 2016) ASD closure 1 late endocarditis (0.06%) 2 hemo. pericardial effusion J2 / M3 (0.12%) 1 late complete AVB (0.06%) 0 significant Aortic/mitral Insufisiency 0 late embolization

23 Same trend in the subgroup of patients with ASD

24 Atrial arrhythmias Most frequent complication after repair AF > 20% even in patients repaired < 25 y.o. AF Stroke Concor Heart 2015

25 PAH after closure

26 CIA and PAH Closure criteria at Marie Lannelongue RVP < 15 UW.m² Steele circulation 1987 Qp/Qs > 1.5 Symptoms onset < 6 m

27 PAH after repair Dutch CONCOR registry, JACC 2015

28 Neurodevelopment

29 Impact of anxiety => ex: Role of play in the understanding of the care

30 ASD and pregnancy 75 successful pregnancy in 67 women with ASD closure 15 y.o. 28 successful pregnancy in 20 women with large ASD 1 post-partum thrombus in out-of-hospital ASO closure Baruteau, Hascoet et al., ACVD 2015 Baruteau circ cardiovasc int 2014

31 Quality of life Cardiol Young Jan;25(1):42-6. QOL of patients with ASD after closure. Eren NK 1, Kırdök AH 2, Kılıçaslan B 3, Kocabaş U 1, Düzel B 1, Berilgen R 1, Nazli C 1, Ergene O 1. We examined the quality of life of 69 patients with atrial septal defect and 69 healthy controls matched according to age, sex, educational level, and economic, marital, and employment status. Quality of life was investigated using the Turkish version of Short Form-36. RESULTS: The mean age of the patients was 39.7 ± 14.2 and 26% were male. The quality of life assessment was performed at a mean follow-up time of 18.0 ± 13.8 months after the intervention. The mean scores of the domains of the Short Form-36, namely, physical functioning, role functioning, social functioning, mental health, vitality, pain, and general health, were similar in patients with atrial septal defect who underwent percutaneous closure and the control group. CONCLUSION: Adult patients who underwent percutaneous atrial septal defect closure perceive their quality of life to be as good as their healthy counterparts.

32 Quality of life Cardiol Young Jan;25(1):42-6. QOL of patients with ASD after closure. Eren NK 1, Kırdök AH 2, Kılıçaslan B 3, Kocabaş U 1, Düzel B 1, Berilgen R 1, Nazli C 1, Ergene O 1. We examined the quality of life of 69 patients with atrial septal defect and 69 healthy controls matched according to age, sex, educational level, and economic, marital, and employment status. Quality of life was investigated using the Turkish version of Short Form-36. RESULTS: The mean age of the patients was 39.7 ± 14.2 and 26% were male. The quality of life assessment was performed at a mean follow-up time of 18.0 ± 13.8 months after the intervention. The mean scores of the domains of the Short Form-36, namely, physical functioning, role functioning, social functioning, mental health, vitality, pain, and general health, were similar in patients with atrial septal defect who underwent percutaneous closure and the control group. CONCLUSION: Adult patients who underwent percutaneous atrial septal defect closure perceive their quality of life to be as good as their healthy counterparts.

33 S. Hascoët Cardiologie pédiatrique et congénitale Hôpital Marie Lannelongue Atrial Septal Defect long-term follow-up after closure Groupe de travail sur le cathétérisme Cardiaque et congénital