Circulation, Vol 79, 1091-1099, Copyright © 1989 by American Heart Association
JE Lock, JJ Rome, R Davis, S Van Praagh, SB Perry, R Van Praagh and JF Keane
Recent experience with the spring-loaded patent ductus arteriosus (PDA)
occluder has demonstrated several advantages of this device in the closure
of intracardiac defects compared with previously described techniques.
Pathologic and animal model studies were performed to identify which atrial
septal defects (ASDs) might be suitable for device closure and to test a
new septal closure double umbrella. Fifty specimens from the Cardiac
Registry with unrepaired ASD secunda (2 degrees) were analyzed. Mean ASD
size was 8 x 10 mm (range, 3 x 4 to 30 x 30 mm); 80% (n = 40) of ASDs were
judged closable with the new device. ASD closure was attempted in four
lambs with the Rashkind (hooked single umbrella) ASD occluder. One of four
umbrellas was correctly positioned; no ASDs were closed. A new
double-hinged ("clamshell") umbrella device was designed: eight ASD
closures were attempted with this device (defects ranged from 8 to 20 mm in
diameter). Six of eight umbrellas were correctly positioned; four of four
animals observed more than 1 day appeared to have complete closure on
postmortem examination with endothelialization of the device. We conclude
that 1) most ASD 2 degrees are far enough from vital structures to permit
closure, 2) initial placement of hooked umbrellas is often incorrect and
cannot be altered, 3) clamshell double umbrellas were successfully placed
in six of eight attempts, and 4) endothelialization of closed ASDs appears
complete within weeks of implantation. These preliminary studies appear
promising and support testing the clamshell ASD device in clinical trials.
ARTICLES
Transcatheter closure of atrial septal defects. Experimental studies
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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