Thanscatheter Closure of Atrial Septal Defects by AmplatzerrM Septal Occluder Instead of
Open Heart Surgery
Kritvikrom Durongpisitktrl, M.D.*
Jtrtrpin Soongs\Iang, M.D.+
Duangnlane€ Laohaprasitipom, M.D.+
Apichart Nana, M,D.+
Thitima Nutakul, M.D.**
Sune€rat Kotrgser€epongse, M.D.**
Nittaya Limpimwons, B.Sc Nursing+
Axhrsr,$rsi. nD.n orsdnduo id'r rD&l dcf.d (^sD) i! ! sare, ndcr, acccpr.d proc€dur w0 nqrisibrc norblit
0nt.hniqut'iDbilitybclp.Ure,!
ocdusioD crhde. GrErhed dianrrrt Thc ,ltr'pt zr r !i4 aaF chc ntrtr G 1 nD). rh€ devie !$ dvr
.sm,l (<2mm) rcsidnalshunr. N0
Ornitlrrdyrrhdbndlr>20nm)soterri"onrlnrich(
.])bkht ot Pt<titrit c47it!{ D+{hti oJ P4tittus. sDtrntusn 4 A"(tn siotop, nrcntt, ,!
fi ril'iirHriri'c{,li{Nllhrfl Em!ft 10leo1i andlo,re sepr.r occtudcr un.mirr_o
qiiitr! l:,iialdti,, i:,r:
nirnorililiri!fiii#orurMio. fi1]olo,li aner'Ls* s.phr ocrudd nniiin andiildaa {.!.,, ndiri qj#N n.!.,1 ir!61 hlhl::irinr y.u.,.
onlri ! r{!.,'inlr !i|]an!"* qdi,1i iq#n!* r!'* nnrr 6!nrirq' 1n.!. ({nlrnmeHa{nriJ'
.n{r|l!mlnniinlli, nri!r)!E,lriFit,snriidaf.!dir0r nufl Mr!fi dei- fi rnolra. !nrirddulnna,nr!xnsallb!.it{runrlar r0?00
0 ' , , _ J r i . { ! r ! r 1 , : ( ' r l q r o ! 0
l s i r f t : + , 1 1 . : i r ; r , i " n , h . . i { d ; m : i s n , i i' , i , . t r " n { ' l l r , . . t r n : ' ' 0 f l d , i , r ! l r r ' D a 4 q " , G f l v l l l i l l : n r
;nq!r!i; &'Dai mn,'nnd}ft,ilfni;'euNm:dai'rlidaq tr0irifllhlAnd'us- seDbL orrudntrNnnrrnin'ilrio,jrlliqnnlft itJ,nd!t;iirl
ir rk fi n) 6i dlcn, ::nidd i.i.i,irdr.i.lit uatiii !.u i ..a, :ni!'r.i,, lnJF
!io!ldt!flre'inrlirMrd?!frli ui'ii!!mlNl;rdi!damliiinlni (barrom m.rNion
0 ! i . ' ! i ( r r r v ? 0 ' 0 ' w n
nniiinli! Amphr*^ i,lnds*indrudln h,irnndl inuarfiuLrillnz !ii!ra!nir!".irfiu lnxnqriruxoFri Ni,iior !J:i!in!;!r'rli;!isft m:nids!innot*dai,r6idDfi!iiinlli
0r!1i!!r )rrr!'r, rflr{0rf ) !({
( . r r i i ( i l . i ! . ! r L o ( , i , . , " i - n i r x : l ' r 4 . n ; u . 6 3 a : l i- ! 1 l i ' i i ! 1 4 4 i l . i - , r ' . n d r a o , ! i : q l d i , r u . d | 7 ) - . . d : ! ' . r . r i i o ' U , s ' u . r r . q a u r , r q ! ' : t r r L d r r o z F l u r r r . r r x w ? D i : ) ' 1 ! i 3 r r ! " ! ) l l f r r . ' r : . i i r i l r . , . : i o ! i , n 0 { r , { ! . h r , 1 . , n 1 . . : : i ' t ! h ' r ' i ,
LnD Yd!r!q!rrst!1 !rern: ! LlD rlnunFrlf. rlle t5 r
secundlm drnl scpbr dd&l(AsD) !.
c o u n b l o ! | 0 % o ' c o i g e n n a L h . a n d n e e a | b n $
A.prd-1- s3ehr o-rd- Li!qdmiinoiirilirii!d1]!;o!!lrnil!!Ndrdnl!
sirirul IIcp Gu
ID.'€cbbyADp|rt..flsepbr oaruder rNrsd oropen r{.,4 suBery 106 xrirvikmn Duonspd&d, d d
rc00n , by Muahy .r 31.: ft 'pp$Ed rhft $e sur viv.l of pdieib who wm op.nbd on b.rorc 25 yec old wirh nomrl puho.ry ftry pi.sur. ws notsignificiidyditr@it rron a iomal popullrioi of igc.bxrch'rd conrols. closm of AsD d a labr
rachyanhythm; or pa..do$cd mbol| Ahhough suBical Epan ofASD i, . sarc 'nd widdy scenrod ptu.olmc wirh dcsligibl. moftliry,I n asocht d dh rofbidiry, di*onrod md a doracoromy se.
lhsdndffdGUco|AsDhNeb.end.wlop.d
rural rd lua, di odgcrcnt and mbolizdion or dc deyice e sode of $e linidlois orprcviaNly prc'
$nb.n @hoiquca, Tbk tudy d.Kribd off .rped' enc. ryir, tm$dhcd dcuE orASD ii pdiciG using ! icw elr.eipandins. s.lr'..ibriis md Epo.
sirioiiis d& icc, rhc AmFlrhrR s.pdl occludei
MATERTALS AND METIIODS
rhc AmpktcrB sepbl oeluder lAaA M.dicar corp., aouen v ley, r'/N, u.s.A.) n con
$nded hon 0.004 0.005 inch Nlhnol (nickel ad rihdum) viEs, rishrly wdfl i0b iwo nd burms (disB) wirh a 4 mm co'ie..ioi eakt (Figur r ). liie
aid 60 nsh dk. 5 nm. rhc lcft dtd k ilighny lrs6
pm*hesis is rilred wnn Deron fablic ro frciriuE
sdill.s !cDl.lt k lod.n iib r lois 6 Frci.h (F;
on. French is equal ro 0.33mn) to s F dirnerer sized lherh For iidd md on ido rhc dcliv.ry she,rh rhc device h pulled into a lGd* (FiguE l).
Firlr' /. Th. Amdahfl sepul occluder held by ne€dle boldtr on.eh side rnn $e brdel
r0Nesoph,8e,r rwo.diftcnsionrr cotor Doppter t,i!ca.h4.. closuE by Anplatzefl scpral ocludc/rrr *@ elecred. Tft criGna gercraily induded koracd seuidm AsD wirh drmeh t*s rhd 32 mm, rtrse Ln b ishr lhud (rario of putmc nary ro syn.mic brood frow or Qp:Qs > L5: D. a di&
bmeof >5nmtummsmrciisor'hcdofd!G)h rhc coorary sinus, {riovenlricule valv* and iichr
which icquned drdi,c 5urysr,, orhB ryp€ orAsD Gius venosus or os'ium piimDf), pdial donl
All dcvl@s !G implanted under a Bemh prorocor appsvcd br rh. Erridrcommir@ otr crini car rnvs'iedion of Fetrhy or Mcdi.i.c sniEj Hos.
pibl.T]reAmpkErfr sepbl occluder *s appovd by rha orficc of cofpriarce, ceds fo' Devics and
mrflitir in"!fii0noiulrM1od1afthiod{
Amlrrcd sepb' occrudcr rftnn,jM'o r07 niriisn'!!:rniaud|i,m:i0:
dn genml aBth*ia cdaoii" (s0 ms^O wA
mibpdk€olheparinwdegivflintdenddy'A
vrs iijsrd ii 'r'. g|l upper plrDdrry Eitr sid'
F billoon 'ipped end holcarhd.i(AtroN Irrema
! o h c , R c d i s , P A , u s A ) w s n s n D u r a r d
rhd{ (Medirsh. wdenowi. MA) {d jntodu4d
tars$ophasol d.hodridiogmphi. (rEE)obssva Rd 'oddemine rhe sErheddiamdslF,suro 2).
!rc'chcd diamec' (1 1 mml rhe derce s?, rcrero
ii'o tl'c loadcr A lons (7 'oe F) gu'dns rh@'h and
by rr{ i,'lcdioD or mird mcdm. nE bad{
,n(r jluorc&opy. fhe T€E *a prformed ro ch{k
Dol,$edcvi..w*rclededbymbtnlockwE was ch4kcd aerii by ,r€E (Fjgure 4) cotrfs* mc.
d; w$ iNded ir rhe igh' drium a' rhe eid or pmoduru b Erify rcsdual auiaL shuir
A crr$ rudiosr{h md a hNrhoilcic mto.
Dopp|q{hm'idiocnehi.ndyweEpelftrnedm dr pdEnr 24 hor ar'n 'he prcdu@. tupiln (5 fs&s)wssNcnonrryirerchp en for 3 moods
rd {riar srN s wo. ngiosr.rphi(,ry ommedi ddy frer r hc proedu €) and cd'o.rd isroohrr Lty ddiocd !s "rbamrg" (nrmfdirtus bart 'hro!3h Dlroi hbi4, tid (rd lerr ruiaLopr.iscdnh orlcr< rnn io d!ndo), smau (jc' I 'o 2 'n'n), modcrarc (ob!io$ r.ft flilr op,.fruron aidnr 3 rol mm) and liLce (ifunk Lcf' rbi, L opllificdr on
RI'SULTS
r8c or 6e odEDc !6 9 6!3.1 ycds ord (2 ro 24 yctus ord).T hcl mmi Mshl ryas 24 7r r4.e k3 ( 10 ? b 50 ks). rhe nH,' AsD diiftr.dcbdiocd by 1l:E vi5 r6 ]!2 mn lr4 'o i3 mm)compircd lnb
l 3 5 a r . s n n ( 1 5 r o ? r n ' n ) . o i c p l n l ( t r o 3 ) h a d syicnii. nos ia'id (ar:ar) NA 3.31t7 ro .r'e fluo.o$opyrmc!620a7.5mi,,03 ro32,iii)aid {i!pm.cduf incv!\?5122 ni. (50 ro 00nn)
hKdtere. crosure ora.rirr serb
sepbr ocdDd.r rnshd drop.n Hq{ suq!ry
r.t!4 2. Tiaqs6ophis.rl eh4idiogm crEE) E3r. J. Deproyins R4uctre or lne Anphhrfl sepbl o(rudd tom rop tcn h borom
ployed l.it fuiai dhc ; rhc.oni.dirs deploy.n : device Eoihd to rhs initirl
conbd wilh lhe mital nol lne ticuspid v,lvc sd
wEk r'chsr radioeruph wa blli itr s.h pdimr p6irioi whci .orpftd wid rhe pEvious 6lm in FirlE 4. rmnssophaFrl echo.sdiostu (r€E) $on ais vic* shwitrs theAsD betue (aA) rnd aPh (a B)
riais hrd a riny rc'dual shud ar rhc connec.ins wi,*. one pdiqt 1rc. 3) hrd r !d,ll shtrdr l'2 hn.
fte nsht opps pulmon,ry vcin. P6ths oI $e AsD
irrhli,nri$i! ii'io{sr!!Nrrutllnal0losln ADPrsorn s.phr o(hdd urln:,find
iqriirru indi6fti ni-0:
T.blc t. Pdiined paried dlb ad ou sD bv rhe Amplltlrtu satd
Pltied ^s. wcisht asD siz. (mm)i 0r) (ke) rEE Bddd
i^sD sik by rEE (dmesophtrcol echoadioenn) or Billoon (bdr.
.dbcct: F.Grud$$opy rime)i F (pceduc 'imc), ap:as G idofpnl'non,ryiosysEmicbhdnow)
DISCUSSION
scveml str(cslul trnsdhecr closues oI 1 'o HdwcEi thc prccenm ha ior yer ehi*d wide.
atrd dnwb{k ii rhc des$ ofrhc o.clusioi devie Ampbrerr! sephl o..lMer wd enPloydd ror drsa$erer do$c orAsD (raryins fmf I5 ro 24 nm) in five pi'icns. complee ocdnsoi v's
wd obsded dunns lhc pmcedur. li lPlr.md d'at iadly due h rhc sinplicity of fte d.lloyme rech
desgnc4 ro ovdcone many or rhc d6wbacks orpre'
$por o.cltrdell which w* .kng.d ro c:rdios@l ad eveNrlly devcldp.d rhc sbrnex sFh (.rur itritror wnc), lnc sidetu buftn d.vi.D," 'ne tuial wins ortrd rh. Pavcrik moiodisk. Bsids rhc sidcas orhq devi.a fquire i laBer 9 F ro l3 Fshearh *hjch
m.ke ftet erili.nioi difilcux or impo$'bro i srdl chirdrn oursmllei pdied M 2 yo6 ord wc{hL ns loJkg. Ccnd'lly our devicc odd bc dcploy.d
D6 Aqd wiis lid $c iev cfin,osal {nh sbrnci bolh or rheD ftqone a krse dcvi.dAsD dbsdd nrio and consequs'rly rhc er.ntion disk hd ro
(ptuhe, which dill ledc ri op.iing rhrcuch 'he AsD, the Amphtlrfl S.pbl o.cluder Nes a shon (4 nm) commuricdhg wtn b "etrr the dersl, forcins brood r'rov dtroueh a nerwolk olhjghry in*ad iicllndoiorbod, rcGr.on dFsallorys fi m
or Pl.moofi inponine for er'@tjrc sd s,re AsD
ftan$r.hcbr closnn or]|hid s.pbl
^tryLilDonldpropdlyoflheAmphlzrrMsepla|
eicalrenorrl. Mo! orrhe de!kcs, *irh rft eiccp
sl'oncr niy in rlrc hospiral(2 ro 3 dayt aid io r)o
CONCLUSIONS
ACKNOWI,I'DGI'MENT
l r ' h s u d y ! $ ! P P ! d b J c n d D 1 5 1 ] ,
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drior rn.n (AsDos)
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fire?rr'
d.diii'nci'ifloi'.ru!,x 6}n10lnt1{
Anpbbdry s*pbr oc.rudd mainidh lrl irwiir! tsiftild'F. n.:io,
lzhsopoulosBD.ddcv'Tsm[itcs'dd'clo'
$rc or add r.p'd deft.b vh e b/@ oEru.
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16'r.cbs,HosYAiddsiRfi'M@holqi€t5dy 'ior iq 'didd dore orr.r'-b.ndl rh@L 3r ',R@Ps'L!4ghaughR''.teMRfi'LlFd'R.sidds
1 3 ' R d } i . c l d H M , v d d . M E ' s t d q i s P ' . l d '
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