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Microembolic signals measured by transcranial Doppler during transcatheter closure of atrial septal defect using the Amplatzer septal occluder

Published online by Cambridge University Press:  22 December 2010

Shinich Itoh ,
Kenji Suda ,
Shintaro Kishimoto ,
Hiroshi Nishino ,
Yoshiyuki Kudo ,
Motofumi Iemura ,
Yozo Teramachi ,
Toyojiro Matsuishi  and
Hiroshi Yasunaga
Shinich Itoh
Affiliation:
Department of Pediatric Cardiology, St. Mary's Hospital, Kurume City, Japan
Kenji Suda*
Affiliation:
Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume University, Kurume City, Japan
Shintaro Kishimoto
Affiliation:
Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume University, Kurume City, Japan
Hiroshi Nishino
Affiliation:
Department of Pediatric Cardiology, St. Mary's Hospital, Kurume City, Japan
Yoshiyuki Kudo
Affiliation:
Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume University, Kurume City, Japan
Motofumi Iemura
Affiliation:
Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume University, Kurume City, Japan
Yozo Teramachi
Affiliation:
Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume University, Kurume City, Japan
Toyojiro Matsuishi
Affiliation:
Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume University, Kurume City, Japan
Hiroshi Yasunaga
Affiliation:
Cardiovascular Surgery, St. Mary's Hospital, Kurume City, Japan
*
Correspondence to: K. Suda, MD, Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume University, Kurume City, 67 Asahi-Machi, 830-0011, Japan. Tel: +81 942 31 7565; Fax: +81 942 38 1792; E-mail: suda_kenji@med.kurume-u.ac.jp
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Abstract

Purpose

To determine the frequency and factors associated with increase in microembolic signals during transcatheter closure of atrial septal defect using the Amplatzer septal occluder.

Methods

During the procedure in 16 patients, we measured microembolic signals using transcranial Doppler. Procedure time was divided into five periods: right cardiac catheterisation; left cardiac catheterisation; left cardiac angiocardiography; sizing and long sheath placement; device placement and release. We compared numbers of microembolic signals among the five periods and identified factors associated with them.

Results

Mean size of septal occluder was 16 millimetres in diameter. Total number of microembolic signals was a median of 31.5, ranging from 3 to 113. Microembolic signals in three periods, left cardiac catheterisation; sizing, and long sheath placement; and device placement and release, were not significantly different from one another, but were significantly higher than those in the remaining two periods, right cardiac catheterisation and left cardiac angiocardiography (median was 9 in left cardiac catheterisation; 6 in sizing and long sheath placement; 6.5 in device placement and release, versus 0 in right cardiac catheterisation and 1 in left cardiac angiocardiography, p less than 0.05, respectively). Importantly, the time for device manipulation positively correlated with total number of microembolic signals (r equals 0.77, p less than 0.001), although fluoroscopic time, age, or size of septal occluder did not.

Conclusions

Transcatheter closure of atrial septal defect using the Amplatzer septal occluder produces microemboli, especially during device placement. To minimise the risk of systemic embolism, we must decrease the time for device manipulation.

Keywords

Catheter interventioninteratrial communicationsystemic embolism
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 2 , April 2011 , pp. 182 - 186
Copyright
Copyright © Cambridge University Press 2010

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