Transcatheter closure of atrial septal defect using fully biodegradable occluder under ultrasound guidance: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Ying'ao ¹ , YAN Yiming ¹ , LI Ziping ¹ , LI Hang ¹ , ZHANG Fengwen ¹ , FANG Fang ¹ , ZHAO Guangzhi ¹ , DONG Jing ¹ , WANG Chuangshi ¹ , WANG Jiande ² ,  OUYANG Wenbin ¹ ,  PAN Xiangbin ¹

1. Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, State Key Laboratory of Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, National Clinical Research Center for Cardiovascular Diseases, Beijing, 100037, P. R. China;
2. Ultrasound Department, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

OUYANG Wenbin, Email: droywb31@163.com; PAN Xiangbin, Email: panxiangbin@fuwaihospital.org

Keywords：

Atrial septal defect; fully biodegradable occluder; echocardiography; transcatheter intervention

DOI：

10.7507/1007-4848.202312032

Video：

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Currently, transcatheter intervention is the preferred treatment for patients with anatomically suitable atrial septal defects. However, the use of nickel-titanium alloy occluders in interventional procedures results in lifelong presence of the implant in the body, leading to complications such as metal allergies and arrhythmias in some patients. To overcome the short-term and long-term complications associated with the presence of metal, and to avoid radiation exposure and metal toxicity, this paper reports a case of successful transcatheter closure of atrial septal defect in a pediatric patient with metal allergies using fully biodegradable occluder under ultrasound guidance, achieving excellent results by interventional therapy.

1.	Sadasivan Nair P, Jaya JS, Comella A, et al. Migraine-like headaches associated with nickel allergy requiring removal of atrial septal defect closure device. Indian J Thorac Cardiovasc Surg, 2021, 37(3): 299-302.
2.	Mullen MJ, Hildick-Smith D, De Giovanni JV, et al. BioSTAR evaluation study (BEST): a prospective, multicenter, phase Ⅰ clinical trial to evaluate the feasibility, efficacy, and safety of the BioSTAR bioabsorbable septal repair implant for the closure of atrial-level shunts. Circulation, 2006, 114(18): 1962-1967.
3.	Shi D, Kang Y, Zhang G, et al. Biodegradable atrial septal defect occluders: a current review. Acta Biomater, 2019, 96: 68-80.
4.	Rao PS, Harris AD. Recent advances in managing septal defects: atrial septal defects. F1000Res, 2017, 6: 2042.
5.	Butera G, De Rosa G, Chessa M, et al. Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol, 2003, 42(2): 241-245.
6.	King TD, Thompson SL, Steiner C, et al. Secundum atrial septal defect: nonoperative closure during cardiac catheterization. JAMA, 1976, 235(23): 2506-2509.
7.	国家卫生健康委员会国家结构性心脏病介入质量控制中心, 国家心血管病中心结构性心脏病介入质量控制中心, 中华医学会心血管病学分会先心病经皮介入治疗指南工作组, 等. 常见先天性心脏病经皮介入治疗指南(2021版). 中华医学杂志, 2021, 101(38): 3054-3076.National Quality Control Center for Intervention of Structural Heart Diseases of National Health Commission, National Quality Control Center for Intervention of Structural Heart Diseases of National Center for Cardiovascular Diseases, Chinese Society of Cardiology, et al. Guideline for percutaneous interventional therapy of common congenital heart diseases (2021 edition). Natl Med J China, 2021, 101(38): 3054-3076.
8.	Agarwal S, Bajaj NS, Kumbhani DJ, et al. Meta-analysis of transcatheter closure versus medical therapy for patent foramen ovale in prevention of recurrent neurological events after presumed paradoxical embolism. JACC Cardiovasc Interv, 2012, 5(7): 777-789.
9.	Huynh K. Antiplatelet therapy: clopidogrel plus aspirin reduces migrane attacks after ASD closure. Nat Rev Cardiol, 2016, 13(1): 2.
10.	施浩, 潘湘斌, 王首正, 等. 单纯超声引导下经颈静脉途径封堵婴幼儿房间隔缺损临床疗效. 中国胸心血管外科临床杂志, 2020, 27(6): 645-648.Shi H, Pan XB, Wang SZ, et al. Clinical efficacy of transjugular device closure of atrial septal defect in infants and young children guided solely by echocardiography. Chin J Thorac Cardiovasc Surg, 2020, 27(6): 645-648.
11.	潘湘斌. 超声引导经皮介入治疗结构性心脏病的探索和发展前景. 中国胸心血管外科临床杂志, 2018, 25(5): 359-361.Pan XB. Exploration and prospect of ultrasound-guided percutaneous interventional therapy for structural heart disease. Chin J Thorac Cardiovasc Surg, 2018, 25(5): 359-361.
12.	潘湘斌, 逄坤静, 欧阳文斌, 等. 单纯超声心动图引导下经皮室间隔缺损封堵术的应用研究. 中国循环杂志, 2015, 30(8): 774-776.Pan XB, Pang KJ, Ouyang WB, et al. Application of percutaneous closure of ventricular septal defect guided solely by transthoracic echocardiography. Chin Circ J, 2015, 30(8): 774-776.
13.	Kong P, Zhao G, Zhang Z, et al. Novel panna guide wire facilitates percutaneous and nonfluoroscopic procedure for atrial septal defect closure: a randomized controlled trial. Circ Cardiovasc Interv, 2020, 13(9): e009281.
14.	高漫辰, 段福建, 张戈军, 等. 经导管缘对缘修复技术初步实践: MitraClip治疗二尖瓣反流多中心早期结果. 中国胸心血管外科临床杂志, 2022, 29(5): 547-552.Gao MC, Duan FJ, Zhang GJ, et al. Preliminary practice of transcatheter edge-to-edge repair technique: early multi-center results of MitraClip for mitral regurgitation. Chin J Thorac Cardiovasc Surg, 2022, 29(5): 547-552.
15.	李文超, 李健, 欧阳文斌, 等. 单纯经胸超声心动图引导经皮介入治疗复杂房间隔缺损的临床疗效. 中国循环杂志, 2023, 38(8): 820-825.Li WC, Li J, Ouyang WB, et al. Clinical efficacy of percutaneous interventional therapy for complex atrial septal defect guided solely by transthoracic echocardiography. Chin Circ J, 2023, 38(8): 820-825.
16.	Wang S, Li Z, Wang Y, et al. Transcatheter closure of perimembranous ventricular septal defect using a novel fully bioabsorbable occluder: multicenter randomized controlled trial. Sci Bull (Beijing), 2023, 68(10): 1051-1059.
17.	Kong P, Liu X, Li Z, et al. Biodegradable cardiac occluder with surface modification by gelatin-peptide conjugate to promote endogenous tissue regeneration. Adv Sci (Weinh), 2023: e2305967.

1. Sadasivan Nair P, Jaya JS, Comella A, et al. Migraine-like headaches associated with nickel allergy requiring removal of atrial septal defect closure device. Indian J Thorac Cardiovasc Surg, 2021, 37(3): 299-302.
2. Mullen MJ, Hildick-Smith D, De Giovanni JV, et al. BioSTAR evaluation study (BEST): a prospective, multicenter, phase Ⅰ clinical trial to evaluate the feasibility, efficacy, and safety of the BioSTAR bioabsorbable septal repair implant for the closure of atrial-level shunts. Circulation, 2006, 114(18): 1962-1967.
3. Shi D, Kang Y, Zhang G, et al. Biodegradable atrial septal defect occluders: a current review. Acta Biomater, 2019, 96: 68-80.
4. Rao PS, Harris AD. Recent advances in managing septal defects: atrial septal defects. F1000Res, 2017, 6: 2042.
5. Butera G, De Rosa G, Chessa M, et al. Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol, 2003, 42(2): 241-245.
6. King TD, Thompson SL, Steiner C, et al. Secundum atrial septal defect: nonoperative closure during cardiac catheterization. JAMA, 1976, 235(23): 2506-2509.
7. 国家卫生健康委员会国家结构性心脏病介入质量控制中心, 国家心血管病中心结构性心脏病介入质量控制中心, 中华医学会心血管病学分会先心病经皮介入治疗指南工作组, 等. 常见先天性心脏病经皮介入治疗指南(2021版). 中华医学杂志, 2021, 101(38): 3054-3076.National Quality Control Center for Intervention of Structural Heart Diseases of National Health Commission, National Quality Control Center for Intervention of Structural Heart Diseases of National Center for Cardiovascular Diseases, Chinese Society of Cardiology, et al. Guideline for percutaneous interventional therapy of common congenital heart diseases (2021 edition). Natl Med J China, 2021, 101(38): 3054-3076.
8. Agarwal S, Bajaj NS, Kumbhani DJ, et al. Meta-analysis of transcatheter closure versus medical therapy for patent foramen ovale in prevention of recurrent neurological events after presumed paradoxical embolism. JACC Cardiovasc Interv, 2012, 5(7): 777-789.
9. Huynh K. Antiplatelet therapy: clopidogrel plus aspirin reduces migrane attacks after ASD closure. Nat Rev Cardiol, 2016, 13(1): 2.
10. 施浩, 潘湘斌, 王首正, 等. 单纯超声引导下经颈静脉途径封堵婴幼儿房间隔缺损临床疗效. 中国胸心血管外科临床杂志, 2020, 27(6): 645-648.Shi H, Pan XB, Wang SZ, et al. Clinical efficacy of transjugular device closure of atrial septal defect in infants and young children guided solely by echocardiography. Chin J Thorac Cardiovasc Surg, 2020, 27(6): 645-648.
11. 潘湘斌. 超声引导经皮介入治疗结构性心脏病的探索和发展前景. 中国胸心血管外科临床杂志, 2018, 25(5): 359-361.Pan XB. Exploration and prospect of ultrasound-guided percutaneous interventional therapy for structural heart disease. Chin J Thorac Cardiovasc Surg, 2018, 25(5): 359-361.
12. 潘湘斌, 逄坤静, 欧阳文斌, 等. 单纯超声心动图引导下经皮室间隔缺损封堵术的应用研究. 中国循环杂志, 2015, 30(8): 774-776.Pan XB, Pang KJ, Ouyang WB, et al. Application of percutaneous closure of ventricular septal defect guided solely by transthoracic echocardiography. Chin Circ J, 2015, 30(8): 774-776.
13. Kong P, Zhao G, Zhang Z, et al. Novel panna guide wire facilitates percutaneous and nonfluoroscopic procedure for atrial septal defect closure: a randomized controlled trial. Circ Cardiovasc Interv, 2020, 13(9): e009281.
14. 高漫辰, 段福建, 张戈军, 等. 经导管缘对缘修复技术初步实践: MitraClip治疗二尖瓣反流多中心早期结果. 中国胸心血管外科临床杂志, 2022, 29(5): 547-552.Gao MC, Duan FJ, Zhang GJ, et al. Preliminary practice of transcatheter edge-to-edge repair technique: early multi-center results of MitraClip for mitral regurgitation. Chin J Thorac Cardiovasc Surg, 2022, 29(5): 547-552.
15. 李文超, 李健, 欧阳文斌, 等. 单纯经胸超声心动图引导经皮介入治疗复杂房间隔缺损的临床疗效. 中国循环杂志, 2023, 38(8): 820-825.Li WC, Li J, Ouyang WB, et al. Clinical efficacy of percutaneous interventional therapy for complex atrial septal defect guided solely by transthoracic echocardiography. Chin Circ J, 2023, 38(8): 820-825.
16. Wang S, Li Z, Wang Y, et al. Transcatheter closure of perimembranous ventricular septal defect using a novel fully bioabsorbable occluder: multicenter randomized controlled trial. Sci Bull (Beijing), 2023, 68(10): 1051-1059.
17. Kong P, Liu X, Li Z, et al. Biodegradable cardiac occluder with surface modification by gelatin-peptide conjugate to promote endogenous tissue regeneration. Adv Sci (Weinh), 2023: e2305967.

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