Figure 2 - available via license: Creative Commons Attribution-NonCommercial 4.0 International
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Neo-endothelialization and thrombus attachment 6 months after implantation. Neo-endothelialization and thrombus attachment in each area of all patients are shown. Thrombus attachment as in Figure 1A is seen in the area marked "Th." Neo-endothelialization of the devices differs among the patients. ASO indicates Amplatzer Septal Occluder; FFX, Figulla Flex II; and Th, thrombus.
Source publication
Background
Current guidelines recommend at least 6 months of antithrombotic therapy and antibiotic prophylaxis after septal‐occluding device deployment in transcatheter closure of atrial septal defect. It has been estimated that it takes ≈6 months for complete neo‐endothelialization; however, neo‐endothelialization has not previously been assessed...
Context in source publication
Context 1
... and thrombus formation in each area of all patients are shown in Figure 2. ASO indicates Amplatzer Septal Occluder; BMI, body mass index; CAF, chronic atrial fibrillation; CI, cardiac index; CO, cardiac output; Cr, creatinine; CRP, C-reactive protein; DAPT, dual antiplatelet therapy; DBP, diastolic blood pressure; DPAP, diastolic pulmonary arterial pressure; EF, ejection fraction (calculated by Simpson's method); eGFR, estimated glomerular filtration rate; FFX, Figulla Flex 2; Hb, hemoglobin; HbA1c, hemoglobin A1c; HR, heart rate; IVC, inferior vena cava; LAVI, left atrial volume index; LDL-C, low-density lipoprotein cholesterol; LVEDV, left ventricular end-diastolic volume; LVESV, left ventricular end-systolic volume; MPAP, mean pulmonary arterial pressure; NT-proBNP, N-terminal pro-B-type natriuretic peptide; OAC, oral anticoagulant; PAF, paroxysmal atrial fibrillation; PCWP, pulmonary capillary wedge pressure; Plt, platelets; RA, right atrium; RVFAC, right ventricular fraction area change; RVEDA, right ventricular end-diastolic area; RVESA, right ventricular end-systolic area; RVSP, right ventricular systolic pressure; SAPT, single antiplatelet therapy; SBP, systolic blood pressure; SPAP, systolic pulmonary arterial pressure; SR, sinus rhythm; TAPSE, tricuspid annular plane systolic excursion; TR, tricuspid regurgitant; and WBC, white blood cell. ...
Citations
... NOGA is an invasive device to demonstrate vessels [6] and inside heart chambers [7]. Recently, the endothelialization on the atrial septal occluder device [13] observed by NOGA was reported. When exploring the VSD by NOGA, it was found that the structure was more complex than the images observed by computed tomography. ...
A ventricular septal defect (VSD) is a common congenital heart disease, and the transcatheter technique for VSD requires practical guidance because it requires a complicated procedure. A non-obstructive angioscopy catheter system via the right ventricle successfully revealed an approximately 3-mm VSD with the shape of a rugby ball at the center of the white membranous septum of Kirklin type II in an older female with suspected coronary artery disease. A white membranous terraced septum was observed to be surrounded by a reddish ventricle. Conservative therapy was performed for her VSD because she did not meet the criteria for surgical treatment.
... [15][16][17] These were also observed in our histopathologic review of cases with extracted devices. A recently published study based on angioscopy evaluation of ASD devices also supported the possibilities of delayed incomplete NE. 41 Although it is challenging to describe the more reliable mechanism, our assessment via CCTA could aid in understanding the natural course of devices with noninvasive and objective modalities. ...
... 31,33,35,42,43 Additionally, our study showed that bulky shape (greater device thickness) was highly correlated with incomplete NE. Structural components of the device might interfere with the NE process; for instance, the fixed stainless steel pin buttons at the center of the device discs might interfere with NE. 44,45 Several reports showed a significant association between bulky shape with greater device thickness and incomplete device NE. 39,41 Although we suggested the cutoff of 21 mm as a predictor for incomplete NE, it is too early to use this value itself to make clinical decisions. Due to the selection bias and other contributing factors, this cutoff value would not necessarily present relevant clinical implications, and this was rather represented to demonstrate the increased risk of incomplete NE in larger devices. ...
Background
Although the transcatheter closure of atrial septal defect was established as the treatment of choice several decades ago, the process of device neoendothelialization (NE) in humans is not well understood. We aimed to measure the extent of device NE using cardiac computed tomography angiography and analyze its risk factors.
Methods
Between January 2005 and February 2021, we retrospectively reviewed 164 devices of 112 patients on cardiac computed tomography angiography. We investigated device shape, contrast opacification within the device that differentiated device NE, and device-related thrombosis or vegetation. Risk factor analysis for major adverse cardiovascular events and incomplete NE according to the postprocedural period was performed.
Results
Seventy patients (62.5%) were women, with a median (range) age at the time of device closure of 44.5 (0.6–79.2) years. The mean (±SD) defect size was 16.6 (±7.8) mm, and patients were followed for 35.9±33.9 months. After 6 months of device implantation, 35% of the devices (42/120) had incomplete NE. The intensity of intradevice opacification shifted from complete to partial or nonopacification over time ( P <0.001), and a similar pattern was observed in the shunt flow ( P <0.001). The bulkiness of devices also decreased in proportion to the postprocedural period ( P <0.001). Risk analysis revealed device diameter (hazard ratio, 1.18 [95% CI, 1.04–1.27]; P <0.001) as the only significant factor of incomplete NE and major adverse events.
Conclusions
Incomplete NE of atrial septal defect devices was identified on cardiac computed tomography angiography in significant numbers after 6 months of the procedure. The device diameter was related to incomplete NE and major adverse events. Further prospective and multicenter studies are warranted to validate this new assessment of device NE.
Scar‐related ventricular tachycardia (VT) ablation involves localizing the critical isthmuses by overdrive pacing maneuvers and three‐dimensional activation mapping. Implantable prosthetic devices have been known to complicate this by covering sites of potential isthmuses. We herein present a sentinel report of scar‐VT ablation with a protected isthmus localized over an endothelialized post‐myocardial infarction ventricular septal defect occluder device.
Background
Ostium secundum atrial septal defect (osASD) is a common congenital heart disease and transcatheter closure is the preferred treatment. Late device-related complications include thrombosis and infective endocarditis (IE). Cardiac tumours are exceedingly rare. The aetiology of a mass attached to an osASD closure device can be challenging to diagnose.
Case Summary
A 74-year-old man with atrial fibrillation was hospitalized for evaluating a left atrial mass discovered incidentally four months earlier. The mass was attached to the left disc of an osASD closure device implanted 3 years before. No shrinkage of the mass was observed despite optimal intensity of anticoagulation. We describe the diagnostic workup and management of the mass that at surgery turned out to be a myxoma.
Discussion
A left atrial mass attached to an osASD closure device rises the suspect of device-related complications. Poor endothelialisation may promote device thrombosis or IE. Cardiac tumours (CT) are rare, and myxoma is the most common primary CT in adults. Although no clear relationship exists between the implantation of an osASD closure device and a myxoma, the development of this tumour is a possible occurrence. Echocardiography and cardiovascular magnetic resonance play a key role in the differential diagnosis between a thrombus and a myxoma, usually identifying distinctive mass features. Nevertheless, sometimes non-invasive imaging may be inconclusive and surgery is necessary to make a definitive diagnosis.
Infective endocarditis is a rare complication of atrial septal defect closure using transcatheter procedure. We report about infective endocarditis in an 8-year-old boy 3 months after transcatheter closure using a Figulla Flex II atrial septal defect occluder. Transesophageal echocardiography showed vegetation attached to the left atrium side of the device. Device removal and atrial septal defect closure were performed. The device was less endothelialized on the left than on the right atrium side. Therefore, insufficient endothelialization may cause infective endocarditis.
Percutaneous atrial septal defect closure is widely used as an alternative to surgical repair in many hospitals. Infective endocarditis related to occluding devices is commonly known, but following that atrial septal defect closure with a device in a child is rare. This report describes an 11-year-old girl who developed late-stage bacterial endocarditis following incomplete endothelialisation after a percutaneous procedure.
