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Closure of an Ostium Secundum ASD in a Child with
Version 2.0 of the GORE ® HELEX Septal Occluder Continued from cover...
The procedure was undertaken under
general anesthesia. Transesophageal
echocardiography demonstrated a
6 mm rim near the aortic root and a
total septal length of 42 mm in the
4-chamber view. We confirmed that
the pulmonary veins drained to the
left atrium. The Eustachian valve was
noted to bulge a little towards the
tricuspid valve, but it did not cause any
turbulence and was distant from the
atrial septum. The distance between the
defect and the AV-valves was 10 mm
and 12 mm to the tricuspid valve and
the mitral annulus, respectively. There
was a notable amount of left to right
shunt across the ASD with a maximum
flow of 1.6 m / s. The pulmonary valve
showed minimal regurgitation and was
mildly enlarged, compared with the
aortic root. Biventricular function was
unrestricted and within the normal
range.
The left femoral vein was punctured
and an 8 Fr short introducer sheath
was inserted. Following an assessment
of pressures and blood saturations, it
was concluded that a significant left to
right shunt was present necessitating
device closure. 1.5 g of cefuroxim and
100 units / kg of heparin were given.
Then, a stiff 0.035” guide wire was
placed across the defect into the left
upper pulmonary vein. Using a 20 mm
sizing balloon, the mildly stretched
diameter of the defect was evaluated
by echocardiography and angiography
simultaneously. Defect measurements
ranged from 10 to 12 mm. To fulfill
the criteria of a 2:1 device diameter to
defect diameter sizing ratio, we elected
to implant a 25 mm GORE ® HELEX
Septal Occluder. The 8 Fr short sheath
Figure 1: Transthoracic echocardiography revealed a 10 mm ASD II with
left to right shunting and enlargement of the right atrium and ventricle.
The overall atrial septal length was estimated as 4.2 cm.
Figure 2: Pre-interventional transesophageal echocardiography
confirmed the transthoracic findings. The ASD II measured as 9 mm
and with sufficient rims.