This volume covers everything you need to know about atrial communications; the pathology, anatomy, physiology, and natural history of treated and untreated patients; indications for intervention; surgical techniques currently used to close such defects; and transcatheter closure of these defects using approved and investigational devices. It also presents imaging techniques for guiding such procedures—including transthoracic echo, transesophageal echo, intracardiac echo, and 2-D and 3-D technology--and using MRI to evaluate patients. Every device currently available, both approved and nonapproved, is discussed in detail along with technical analyses of how to close defects. In addition to addressing the association between PFOs and strokes and migraines, the contributors examine the status of all trials addressing transcatheter closure of ASDs and PFOs.

Part 1: Anatomy, Pathophysiology, and Natural History

1. Anatomy of the Atrial Septum
Paul Weinberg, Akash R. Patel, Lisa C. A. D'Alessandro

2. Natural and Unnatural History of a Secundum ASD
Thomas Graham, Tom Doyle, Greg Fleming

3. Atrial Septal Defects: Clinical Perspectives
Wail Alkashkari, Ziyad M. Hijazi

4. Historical Perspectives on ASD Device Closure
Terry King, Noel L. Mills

5. PFO Closure for Prevention of Recurrent Stroke and TIA
Ted Feldman

6. PFO and Migraines
Jonathan Tobis, Swarnendra Verma


Part 2: Imaging and Assessment

7. Imaging to Guide ASD and PFO Closure—TTE and TEE
Sinai C. Zyblewski, Girish S. Shirali

8. Imaging to Guide ASD and PFO Closure: Intracardiac Echocardiography (ICE)
Mustafa Al-Qbandi, Qi-Ling Cao, Ziyad M. Hijazi

9. Ct Evaluation of the Interatrial Septum in ASDs
Robert A. Quaife, John D. Carroll

10. Cardiac Magnetic Resonance Assessment of ASDs and PFOs: Relation to Pre Device Closure and Post
Mark Fogel


Part 3: Procedure Techniques

11. Establishing a Program in Structural Heart Disease Interventional Therapies
Ted Feldman, Ziyad M. Hijazi

12. How to Close Simple Atrial Septal Defects
Matthew Egan, Ralf J. Holzer

13. Device Closure of Difficult ASDs
Mustafa Al-Qbandi, Ziyad M. Hijazi

14. Device Closure of ASDs in Small Children
Mustafa Al-Qbandi, Ziyad M. Hijazi

15. Device Closure of ASDs and PFOs in the Elderly: Hemodynamic Assessment
Mehmet Cilingiroglu, Ted Feldman

16. Closure of ASDs with Pulmonary Hypertension: Assessing Operability
Sara M. Trucco, William E. Hellenbrand

17. Device Closure of ASDs in Patients with R-L Shunt
Anas Salkini, John W. Moore

18. Device Closure of Fenestrations Post Fontan Operation
Mustafa Al-Qbandi, Ziyad M. Hijazi

19. Unusual Vascular Access to Close ASDs and PFOs
Larry A. Latson

20. Transcatheter ASD Closure without Fluoroscopy
Peter Ewert, Felix Berger

21. New Minimally Invasive Techniques for Surgical Closure of ASDs and PFOs
Nikolay V. Vasilyev, Pedro J. del Nido

22. Complications of Device Closure of ASDs and PFOs
Zahid Amin

23. Nightmare Cases in the Cardiac Catheterization Laboratory during Percutaneous Closure of ASD
Mustafa Al-Qbandi, Tarek Momenah, Ziyad M. Hijazi

24. My Worst Nightmare Cases of PFO Closure
Tina Lehr, Sonya Joy, Kristina Renkhoff, Nina Wunderlich, Horst Sievert


Part 4: Devices

25. Engineering Aspects of Metallic and Bioabsorbable Devices
Carol A. Devellian, Stephanie M. Kladakis, Steven W. Opolski, John A. Wright Jr.

26. The Amplatzer Devices for ASDs and PFOs
Trong-Phi Le, Horst Sievert

27. The Gore Helex Septal Occluder
Ted Feldman

28. The Occlutech Flex Devices for ASD and PFO
Horst Sievert, Nicolas Majunke, Nina Wunderlich

29. Transcatheter Patch Device
Basilios E. Sideris, John Coulson, Eleftherios B. Sideris

30. The CardioSEAL®/STARFlex® Family of Devices for Closure of Atrial Level Defects
Paul Kramer

31. Bioabsorbable Devices: The BioSTAR and BioTREK for ASD and PFO
Ryan Ko, Michael J. Mullen

32. Cardia Devices
Daniel R. Turner, Thomas J. Forbes

33. The Solysafe Septal Occluder for the Closure of ASDs and PFOs
Peter Ewert

34. The Pfm Device for ASD Closure
Miguel Granja, Franz Freudenthal

35. The Coherex Flatstent
Olaf Franzen, Stephan Baldus

36. The Premere Device for PFO Closure
Jennifer Franke, Stefan Bertog, Horst Sievert


CONTRIBUTORS:

Wail Alkashkari MD
Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois

Zahid Amin MD
Professor of Pediatrics, and Director of Cardiac Catheterization and Hybrid Suites, Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, Illinois

Stephan Baldus MD
Department of Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Prof. Felix Berger MD
Director of the Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Institute Berlin and Charité--Medical University Berlin, Germany

Stefan Bertog MD
CardioVascular Center Frankfurt, Germany

Qi-Ling Cao MD
Associate Professor, and Director of Echocardiography Research Laboratory, Rush Center for Congenital and Structural Heart Disease, Section of Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois

John D. Carroll MD
Professor of Medicine, University of Colorado, Denver; Director of Interventional Cardiology and Medical Director of Cardiac and Vascular Center, University of Colorado Hospital, Denver, Colorado

Mehmet Cilingiroglu MD, FESC, FACC, FSCAI
NorthShore University HealthSystem--Evanston Hospital, Evanston, Illinois

John D. Coulson MD
Clinical Associate, Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland

Lisa C. A. D'Alessandro MD
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Pedro J. del Nido MD
William E. Ladd Professor and Chairman of the Department of Cardiac Surgery, Children's Hospital--Boston, Harvard Medical School, Boston, Massachusetts

Carol A. Devellian BS
Vice President, Research and Development, NMT Medical, Inc., Boston, Massachusetts

Thomas Doyle MD
Ann and Monroe Carell Jr. Family Associate Professor of Pediatrics, Vanderbilt University; Clinical Director of the Division of Pediatric Cardiology; Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee

Matthew Egan MD
Heart Center, Nationwide Children's Hospital, Columbus, Ohio

Peter Ewert MD, PhD
Deputy Director of the Department of Congenital Heart Disease/Pediatric Cardiology, and Head of the Catheterization Laboratory, German Heart Institute Berlin; Department of Pediatric Cardiology, Pediatric Intensive Care, Congenital Heart Diseases in Adults, Senior Lecturer, Department of Pediatrics, Otto Heubner Center for Pediatric and Adolescent Medicine, Charité--Medical University Berlin, Germany

Gregory A Fleming. MD, MSCI
Clinical Instructor, Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee

Mark A. Fogel MD, FACC, FAHA, FAAP
Associate Professor of Cardiology and Radiology; Director of Cardiac Magnetic Resonance, Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Thomas J. Forbes MD, FSCAI, FACC
Associate Professor, Carman and Ann Adams Department of Pediatrics, and Director of the Cardiac Catheterization Laboratory, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, Michigan

Jennifer Franke MD
CardioVascular Center Frankfurt, Germany

Olaf Franzen MD
Department of Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Franz Freudenthal MD
Department of Pediatric Cardiology, Kardiozentrum, La Paz, Bolivia

Thomas P. Graham Jr. MD
Emeritus Professsor, Pediatric Heart Institute, Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee

Miguel Granja MD
Chief of the Interventional Cardiology Laboratory at the Pedro de Elizalde Children's Hospital of Buenos Aires; Chief of Interventional Cardiology in Congenital Heart Disease Laboratories, Heart Institute of the Italian Hospital of Buenos Aires; Associate Professor, University of Buenos Aires, Argentina.

William E. Hellenbrand MD
Director of the Division of Pediatric Cardiology, Columbia College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York--Presbyterian, New York

Ralf J. Holzer MD, MSc, FSCAI
Assistant Director of the Cardiac Catheterization & Interventional Therapy, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio; Associate Professor of Pediatrics, The Ohio State University School of Medicine, Columbus, Ohio

Sonya Joy
CardioVascular Center Frankfurt, Germany

Terry Dean King MD
Director of Pediatrics, St. Francis Medical Center, Monroe, Louisiana; Clinical Professor of Pediatrics, LSU School of Medicine; Clinical Professor of Pediatrics, Tulane School of Medicine, New Orleans, Louisiana

Stephanie M. Kladakis PhD
Program Manager, NMT Medical, Inc., Boston, Massachusetts

Ryan Ko MBBS, MPCP
Adult Congenital Heart Disease Unit, Royal Brompton Hospital, London, United Kingdom

Paul Kramer MD, FACC, FSCAI
Director of the Cardiac Catheterization Laboratory, Liberty Regional Cardiac and Vascular Center, Liberty Hospital, Liberty, Missouri

Larry A. Latson MD
Center for Pediatric and Congenital Heart Diseases, Children's Hospital, Cleveland Clinic, Cleveland, Ohio

Trong-Phi Lê MD
Head of Pediatric Catheterization Laboratory, Vice Director of the Department of Pediatric Cardiology, Heart Center, University of Hamburg, Germany

Tina Lehr
CardioVascular Center Frankfurt, Germany

Nicolas Majunke MD
CardioVascular Center Frankfurt, Germany; Heart Center, Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany

Noel L. Mills MD
Clinical Professor of Surgery, Tulane School of Medicine, New Orleans, Louisiana

Tarek S. Momenah MBBS, DCH, FAAP, FRCPC, FACC
Senior Consultant and Director of Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia

John W. Moore MD, MPH
Professor of Pediatrics, Pediatric Cardiology Section Chief, Department of Pediatrics, University of California--San Diego School of Medicine; Director of the Division of Cardiology, Rady Children's Hospital, San Diego, California

Michael J. Mullen MD, FRCP
Lead for Structural Heart Intervention, Consultant Cardiologist, The Heart Hospital, University College Hospital, NHS Foundation Trust, London, United Kingdom

Steven W. Opolski MS
Senior Technical Consultant, NMT Medical, Inc., Boston, Massachusetts

Akash R. Patel MD
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

Robert A. Quaife MD
Director of Advanced Cardiac Imaging; Associate Professor of Medicine and Radiology, Cardiac and Vascular Center, University of Colorado, Denver, Colorado

Kristina Renkhoff
CardioVascular Center Frankfurt, Germany

Anas Salkini MD
Senior Interventional Pediatric Cardiology Fellow, Section of Cardiology, Department of Pediatrics, University of California--San Diego School of Medicine, Rady Children's Hospital, San Diego, California

Girish S. Shirali MBBS, FACC, FASE
Professor, Departments of Pediatrics and Obstetrics/Gynecology; Vice-Chairman for Fellowship Education, Department of Pediatrics; Director of Pediatric Echocardiography; Director of Pediatric Cardiology Fellowship Training, Medical University of South Carolina, Charleston, South Carolina

Basilios E. Sideris BS (Biomedical Engineering)
Athenian Institute of Pediatric Cardiology, Athens, Greece

Eleftherios B. Sideris MD
Director of the Athenian Institute of Pediatric Cardiology, Athens, Greece

Jonathan Tobis MD
Director of Interventional Cardiology, UCLA Medical Center; Professor of Medicine, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), California

Sara M. Trucco MD
Pediatric Interventional Catheterization Fellow, Columbia College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York--Presbyterian, New York

Daniel R. Turner MD, FAAP, FACC
Associate Professor, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine; Interventional Cardiologist, Children's Hospital of Michigan, Detroit, Michigan

Nikolay V. Vasilyev MD
Staff Scientist, Department of Cardiac Surgery, Children's Hospital--Boston; Instructor in Surgery, Division of Surgery, Harvard Medical School, Boston, Massachusetts

Swarnendra Verma MD
Division of Interventional Cardiology, UCLA Medical Center, David Geffen School of Medicine at the University of California, Los Angeles

Paul M. Weinberg MD, FAAP, FACC
Director of the Fellowship Training Program in Pediatric Cardiology, Senior Cardiologist, and Professor of Pediatrics and Pediatric Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

John A. Wright Jr. MS
Director of Research and Development, NMT Medical, Inc., Boston, Massachusetts

Nina Wunderlich MD
CardioVascular Center Frankfurt, Germany

Sinai C. Zyblewski MD
Assistant Professor, Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina

Ziyad M. Hijazi, MD, MPH, FSCAI, FACC, FAAP, Director of the Rush Center for Congenital and Structural Heart Disease, Pediatric Cardiology Section Chief, and Professor of Pediatrics and Internal Medicine, Rush University Medical Center, Chicago, Illinois

Ted Feldman, MD, FSCAI, FACC, FESC, Director of the Cardiac Catheterization Laboratory, NorthShore University HealthSystem–Evanston Hospital, Evanston, Illinois

Mustafa H. Abdullah Al-Qbandi, MD, DCH, FAAP, FRCPc, FAAC, FSCAI, Consultant Pediatrician, Pediatric Cardiologist, and Head of Pediatric Cardiology Unit,, Chest Diseases Hospital, Kuwait Cardiac Centre, Kuwait

Horst Sievert, MD, FSCAI, FACC, FESC, FICA, Director of the CardioVascular Center Frankfurt, Sankt Katharinen Hospital, Frankfurt; Director of the Department of Internal Medicine, Cardiology and Vascular Medicine, Sankt Katharinen Hospital, Frankfurt; Professor of Medicine, Johann Wolfgang Goethe University, Frankfurt, Germany