By Andres M. Pineda MD and Nirat Beohar MD
The number of adults with intracardiac defects is expected to rise over the next decade primarily as a result of the increasing prevalence of adult congenital heart disease and some acquired defects. Atrial septal defect (ASD), patent foramen ovale (PFO), ventricular septal defect (VSD), and prosthetic valve paravalvular regurgitation (PVR) are the most frequent intracardiac defects encountered in the adult population in current practice. Although in the past most of these defects were managed surgically, with the advances in cardiac imaging, device technology, and transcatheter techniques, percutaneous closure is now feasible and safe for most intracardiac defects in adults. Our manuscript in this month’s issues of the Journal of Invasive Cardiology is a comprehensive review of the current transcatheter management of the most common defects in adults. This review focuses on adult-specific clinical challenges, key technical aspects, the evidence for, current indications, and future directions of device closure of ASDs, PFOs, VSDs, and PVRs.
Device closure is currently considered first-line therapy for ostium secundum ASDs and muscular VSDs. It has also been used for patients with challenging anatomies or clinical scenarios, including those with ASD with deficient rims, older adults at risk for heart failure after ASD closure, or non-muscular VSDs. Percutaneous closure of PFOs has been successfully used for the treatment of major decompression illness in scuba divers, platypnea-orthodeoxia syndrome, and may reduce migraine episodes. In high-risk patients, PFO closure may also prevent recurrent cerebrovascular events after cryptogenic stroke. Transcatheter closure of PVR after transcatheter or surgical prosthetic valve replacement has been successfully performed and is an excellent alternative avoiding the high risk of surgical reintervention.
Read the entire review here:
Pineda AM, Mihos CG, Singla S, Santana O, Rhodes J, Sommer RJ, Rihal CS, Beohar N. Percutaneous closure of intracardiac defects in adults: state of the art. J Invasive Cardiol 2015;27(12):561-572.