Ostium Secundum Atrial Septal Defect Closure Thomas Hoy March 24, 2004 Department of Biomedical Engineering BME 272 Senior Design

Significance of Project Isolated secundum atrial septal defects account for ~ 7% of congenital cardiac defects. Isolated secundum atrial septal defects account for ~ 7% of congenital cardiac defects. CHD of significance occur in ~ 8 in 1000 live births. CHD of significance occur in ~ 8 in 1000 live births. If untreated can cause: If untreated can cause: Congestive Heart FailureCongestive Heart Failure Pulmonary Vascular DiseasePulmonary Vascular Disease

Existing Solutions Invasive Approach Transcatheter Approach Direct suture FDA approved devices Pericardial patchExperimental devices Pericardial patchExperimental devices

Transcatheter Approach

Problems with Existing Devices Difficulty centering the device in larger defects [57] Difficulty centering the device in larger defects [57] Wire related problems Wire related problems Wire fractures [58]Wire fractures [58] Atrial / mitral valve perforation [59]Atrial / mitral valve perforation [59] Wire migration [60]Wire migration [60] Difficulty in device retrieval [61]Difficulty in device retrieval [61] Expense Expense

Project Design Goals Develop a less costly / more simplistic occlusion deviceDevelop a less costly / more simplistic occlusion device Develop a device that is easily centered on the ASDDevelop a device that is easily centered on the ASD Ensure ease use in the medical environmentEnsure ease use in the medical environment Stimulate endotheliazation of the deviceStimulate endotheliazation of the device Increase the possible success rate in the application of the deviceIncrease the possible success rate in the application of the device

Design Proposal 1 Double Balloon Catheter Double Balloon Catheter Inflate across the septumInflate across the septum Position on the ASDPosition on the ASD Adhere via an activated adhesive to the atrial rim on the septumAdhere via an activated adhesive to the atrial rim on the septum Deflate the balloon to form a thin membraneDeflate the balloon to form a thin membrane Extract lead wireExtract lead wire

Advantages No wire related problems No wire related problems Double balloon device requires a septal rim slightly larger than the defect [62,63] Double balloon device requires a septal rim slightly larger than the defect [62,63] Costs associated with the device Costs associated with the device Spherical shape of the device is ideal for centering; however is quite bulky Spherical shape of the device is ideal for centering; however is quite bulky

Future Work Researching heat-activated adhesives that may be used in a biological setting Researching heat-activated adhesives that may be used in a biological setting Developing a preliminary model representing the theoretical aspect of the device Developing a preliminary model representing the theoretical aspect of the device

References [57] Sideris EB, Leung M, Yoon JH, et al. Occlusion of large atrial septal defects with a centering buttoned device. Am Heart J 1996;131; [57] Sideris EB, Leung M, Yoon JH, et al. Occlusion of large atrial septal defects with a centering buttoned device. Am Heart J 1996;131; [58] Prieto LR, Foreman CK, Cheatham JP, Latson LA. Intermediate-term outcome of transcatheter secundum atrial septal defect closure, using the Bard Clamshell septal occluder. Am J Cardiol 1996;78: [58] Prieto LR, Foreman CK, Cheatham JP, Latson LA. Intermediate-term outcome of transcatheter secundum atrial septal defect closure, using the Bard Clamshell septal occluder. Am J Cardiol 1996;78: [59] Silvert H, Babic M, Ensslen R. Transcatheter closure of large atrial septal defects with the Babic system. Cathet Cardiovasc Diagn 1995;36: [59] Silvert H, Babic M, Ensslen R. Transcatheter closure of large atrial septal defects with the Babic system. Cathet Cardiovasc Diagn 1995;36: [60] Rao PS, Sideris EB, Hausdorf G, et al. International experience with secundum atrial septal defect occlusion by the buttoned device. Am Heart J 1994; 128: [60] Rao PS, Sideris EB, Hausdorf G, et al. International experience with secundum atrial septal defect occlusion by the buttoned device. Am Heart J 1994; 128: [61] Agarwal SK, Ghosh PK, Mittal PK. Failure of devices used for closure of atrial septal defects mechanisms and management. J Thorac Cardiovasc Surg 1996;112: [61] Agarwal SK, Ghosh PK, Mittal PK. Failure of devices used for closure of atrial septal defects mechanisms and management. J Thorac Cardiovasc Surg 1996;112: [62] Sideris EB, Sideris SE, Thanopoulos BD, Ehly RL, Fowlkes JP. Transvenous atrial septal defect occlusion by the buttoned device. Am J Cardiol 1990;66: [62] Sideris EB, Sideris SE, Thanopoulos BD, Ehly RL, Fowlkes JP. Transvenous atrial septal defect occlusion by the buttoned device. Am J Cardiol 1990;66: [63] Das GS, Voss G, Jarvis G, Wyche K, Gunther R, Wilson RF. Experimental atrial septal defect closure with a new, transcatheter, self- centering device. Circulation 1997;96(Suppl):I [63] Das GS, Voss G, Jarvis G, Wyche K, Gunther R, Wilson RF. Experimental atrial septal defect closure with a new, transcatheter, self- centering device. Circulation 1997;96(Suppl):I-3177.