Cooper Heart Institute Offers Interventional ASD Closures Addition of Intracardiac Echo Allows for Safe, Effective Closures

Adding to their arsenal of advanced treatment options, the Cooper Heart Institute is now offering interventional closure of atrial septal defects (ASD’s). Cooper University Hospital is one of only two facilities in South Jersey utilizing the transcatheter closure technique with state-of-the-art intracardiac echocardiography (ICE).

Figure A) Deployment catheter is advanced partially through the right atrium into the left atrium straddling the site of the ASD. Figure B) The left atrial side of the closure disk is deployed. Figure C) The right atrial side of the closure disk is deployed. Figure D) Closure device is anchored in place by hemodynamic pressure.

ASD’s, congenital defects in the structure of the atrial septum resulting in oxygenated blood being shunted from the left to the right atrium, comprise 10% of all congenital defects. However, ASD’s account for over 50% of the adults presenting with previously undetected congenital disease. The severity of symptoms and patient presentation is dependent on the size of the septal wall defect, the amount of left-right shunting, and the volume load on the pulmonary vascular bed. Pulmonary occlusive diseases such as pulmonary hypertension may be the result of prolonged volume overload in this population.

Determining Treatment

Determining Treatment Adults with ASD present most often with palpitations, heart murmurs, dyspnea, and arrhythmias. Echocardiographic exams usually demonstrated significant left to right shunting. “The determination for treatment is based on the amount of shunting,” says Janah Aji, M.D., director of the Cooper University Hospital Cardiac Catheterization Laboratory. “ It is generally accepted that a shunt ratio of 1.6 or higher requires treatment. Historically, no treatment has been recommended in patients with no shunting. However, that position is under debate at this time, since ASD closure can be accomplished now without surgery. Many clinicians feel that the benefits outweigh the risks, and that all ASD’s should be closed,” he adds.

Utilizing ICE

Until recently, treatment options for ASD’s were limited to surgical closure. Interventional repairs became a viable option with the development of new occlusion devices and the refinement of intracardiac echo (ICE) technology. “There are distinct advantages to the use of intracardiac echo during the transcatheter ASD repairs,” says Elias Iliadis, M.D., Cooper interventional cardiologist. “Enhanced image quality allows for exceptional evaluation of atrial septal morphology – key to optimal device selection and placement.” “However,” adds Dr.Iliadis “the most obvious patient benefit is that no anesthesia is required, a necessity with transesophageal echo (TEE).”

The Procedure

Cooper interventional cardiology utilizes the only FDA approved device, the Amplatzer Septal Occluder. The device, two connected biocompatible disks, is introduced via the femoral vein. Using ICE, the Occluder is positioned across the atrial septum with the right atrial disk deployed first, followed by the left. An overnight hospitalization is recommended, though reported complications are rare. Unlike patent foreman ovale (PFO) which shunts blood from right to left and has a flap-like opening, a transcatheter closure of an ASD cannot be utilized in patients whose septal defects do not have an anatomical rim. A tissue rim of at least 5mm is necessary to position the occlusion device effectively. Patients without the necessary rim are referred to Cooper cardiovascular surgeons for repair.

Comprehensive Services

“Transcatheter ASD closures add another dimension to a program noted for excellence,” says Joseph Parrillo, M.D., director of the Cooper Heart Institute. “These options coupled with the 24/7 urgent transport program and emergent catheterization services, allow Cooper Heart Institute to provide patients with the most advanced interventional options available today in cardiovascular care.”

To speak with Dr. Aji about ASD closure, or to refer a patient, please call: (856) 342-2034.