Percutane ingrepen bij volwassenen met congenitale hartziekten ...
Percutane ingrepen bij volwassenen met congenitale hartziekten ...
Percutane ingrepen bij volwassenen met congenitale hartziekten ...
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CardVasz Symposium<br />
Utrecht, 2 december 2011<br />
<strong>Percutane</strong> <strong>ingrepen</strong> <strong>bij</strong> <strong>volwassenen</strong> <strong>met</strong><br />
<strong>congenitale</strong> <strong>hartziekten</strong><br />
Robbert J de Winter MD PhD FESC<br />
Academic Medical Center<br />
University of Amsterdam<br />
The Netherlands<br />
AMC Amsterdam Interventional Cardiology
%<br />
0.8<br />
Aantal patienten <strong>met</strong> AHA<br />
1980<br />
10 20 30 40 50<br />
age<br />
10<br />
20<br />
30<br />
2008<br />
40<br />
?<br />
50<br />
60
Europa: 728 miljoen inwoners<br />
Prognose onbekend<br />
50.000 in NL<br />
2.4 miljoen patiënten <strong>met</strong> een<br />
aangeboren hartafwijking
CONCOR<br />
National registry and DNA-bank of CONgenital CORvitia<br />
• Sinds 2001<br />
• Data- en DNA bank<br />
10.000 patienten<br />
• Volwassen patienten uit 102 centra<br />
• Onderzoek naar:<br />
− Lange termijn uitkomsten<br />
− Genetica van aangeboren hartafwijkingen
CVA or TIA<br />
Aortic complications<br />
Endocarditis<br />
Pulmonary hypertension<br />
Systemic hypertension<br />
Arrhythmias<br />
Late complicaties<br />
Late Complications<br />
3%<br />
3%<br />
3%<br />
5%<br />
6%<br />
N=10.000<br />
27%<br />
0 500 1000 1500 2000 2500<br />
Number of patients
Leeftijd 32 jaar<br />
(18-91)<br />
51% man<br />
5%<br />
5%<br />
4%<br />
Hoofddiagnoses CONCOR<br />
2%<br />
2%<br />
7%<br />
2%<br />
12%<br />
10%<br />
10%<br />
N=10.000<br />
16%<br />
11%<br />
14%<br />
Atrial septal defect<br />
Ventricular septal defect<br />
Tetralogy of Fallot<br />
Aortic coarctation<br />
Aortic stenosis<br />
Pulmonary stenosis<br />
Transposition of the great arteries<br />
Marfan syndrome<br />
Bicuspid aortic valve<br />
Pulmonary atresia<br />
AV septal defect<br />
Ebstein's anomaly<br />
Other defects
<strong>Percutane</strong> <strong>ingrepen</strong> <strong>bij</strong> <strong>volwassenen</strong> <strong>met</strong><br />
Congenitale hartaandoening<br />
• Multi disciplinaire benadering<br />
• Kinder cardioloog<br />
• Congenitaal cardioloog<br />
• Congenitaal cardiochirurg<br />
• Imaging cardioloog<br />
• Imaging kinder cardioloog<br />
• Interventie cardioloog<br />
• Cathlab verpleegkundige<br />
• Congenitaal verpleegkundige<br />
AMC Amsterdam Interventional Cardiology
<strong>Percutane</strong> <strong>ingrepen</strong> <strong>bij</strong> <strong>volwassenen</strong> <strong>met</strong><br />
Congenitale hartaandoening<br />
• ASD II<br />
•PFO<br />
• Coarctatio Aortae<br />
• ODB<br />
• PV valvuloplastiek<br />
• AP stentplaatsing<br />
• AoV valvuloplastiek<br />
• <strong>Percutane</strong> PV klep implantatie (Melody)<br />
• VSD<br />
• Overig (n=1 procedures)<br />
AMC Amsterdam Interventional Cardiology
<strong>Percutane</strong> <strong>ingrepen</strong> <strong>bij</strong> <strong>volwassenen</strong> <strong>met</strong><br />
Congenitale hartaandoening<br />
• ASD II<br />
•PFO<br />
• Coarctatio Aortae<br />
• ODB<br />
• PV valvuloplastiek<br />
• AP stentplaatsing<br />
• AoV valvuloplastiek<br />
• <strong>Percutane</strong> PV klep implantatie (Melody)<br />
• VSD<br />
• Overig (n=1 procedures)<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
Heart Murmur<br />
Dyspnea on exertion<br />
Atrial Arrhythmia<br />
Stroke / TIA<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
AMC Amsterdam Interventional Cardiology
AMC Amsterdam Interventional Cardiology
Indications for Atrial Septal Defect closure<br />
Symptoms<br />
Dyspnea, fatique, overt HF<br />
Arrhythmia’s<br />
Paradoxical embolism<br />
Migraine headache’s<br />
L-R Shunt<br />
2:1, 1.5:1<br />
Reversible Pulm Hypertension<br />
AMC Amsterdam Interventional Cardiology
Treatment: Atrial Septal Defect<br />
<strong>Percutane</strong>ous closure<br />
Surgery<br />
Medical treatment<br />
AMC Amsterdam Interventional Cardiology
Amplatzer Septal Occluder<br />
AMC Amsterdam Interventional Cardiology
Amplatzer Septal Occluder<br />
AGA Medical Website: www.amplatzer.com<br />
AMC Amsterdam Interventional Cardiology
ASD Closure: Procedural Overview<br />
AMC Amsterdam Interventional Cardiology
ASD Closure: Procedural Overview<br />
AMC Amsterdam Interventional Cardiology
ASD Closure: Procedural Overview<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Check angle of approach<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
Transcatheter Closure: Atrial Septal Defects<br />
Common problems encountered<br />
during transcatheter ASD closure<br />
procedures<br />
AMC Amsterdam Interventional Cardiology
Transcatheter Closure: Atrial Septal Defects<br />
The hole is really big<br />
On withdrawal, the device keeps<br />
prolapsing through the defect<br />
Sizing ballon too small, does not<br />
eliminate flow<br />
AMC Amsterdam Interventional Cardiology
Careful balloon sizing<br />
AMC Amsterdam Interventional Cardiology
Careful balloon sizing<br />
AMC Amsterdam Interventional Cardiology
Check septal rim dimensions<br />
AMC Amsterdam Interventional Cardiology
AMC Amsterdam Interventional Cardiology
<strong>Percutane</strong> ASD sluiting<br />
• Bloedings complicaties<br />
• Boezem ritme stoornissen<br />
• Recidief ASD<br />
• Arteriele thrombo embolie<br />
• Device luxatie<br />
• Erosie boezemseptum<br />
• Erosie Aorta<br />
AMC Amsterdam Interventional Cardiology
Diagnosis: Atrial Septal Defect<br />
AMC Amsterdam Interventional Cardiology
ASD-II<br />
AMC Amsterdam Interventional Cardiology
<strong>Percutane</strong> ASD sluiting<br />
• Nabehandeling<br />
• ASA gedurende 6 maanden<br />
• Clopidogrel gedurende 6 maanden<br />
• Endocarditis profylaxe<br />
• Echo controle<br />
• Bij Cryptogene Stroke<br />
• ASA indien geen contra indicaties<br />
• Tenzij “bewezen paradoxe embolus”<br />
AMC Amsterdam Interventional Cardiology
When NOT to close ASD<br />
Pulmonary hypertension<br />
PVRI > 10 units<br />
Associated cyanosis<br />
ASD in setting of severe LV dysfunction<br />
Small defect clinically inapparent previously<br />
Clinical CHF: shunt PV congestion or both<br />
Very high LA mean pressure<br />
AMC Amsterdam Interventional Cardiology
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