viernes, 1 de febrero de 2019

Percutaneous Closure Procedure

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By Gaea Marelle Miranda, M.Sc.Reviewed by Tomislav Meštrović, MD, PhD

Percutaneous closure can be described as a less-invasive surgical procedure that is used to treat patients with atrial septal defect (ASD) or patent foramen ovale (PFO). Since the utilization of percutaneous closure has evolved over the years, clinicians have already discovered multiple and less invasive methods in treatment, such as catheterization.

Contemporary research proposes the use of this procedure as an alternative to other common and more invasive methods. While percutaneous closure is also a surgical process, its success rate and ease-of-use over alternatives has made it a primary choice in treating ASD and PFO.

Because patients with AS and PFO were empirically found to have higher survival rates when treated using surgical procedures, many interventional studies on the topic have been published. For instance, there is evidence of catheterization and percutaneous occlusion devices as effective treatment modalities for the condition. While percutaneous closure is limited only to small diameters, current research projects are trying to expand the treatment scope of the procedure.

Preparing for Percutaneous Closure

Patients expecting to undergo percutaneous closure should be well-prepared and well-informed of the procedure. Both young and adult patients should be kept in check regarding the following preparations prior to treatment.

Testing for cardiac functions – Patients acquiring percutaneous closure either for ASD or PFO should have been screened using cardiac MRI or echocardiogram. This allows doctors to visualize the problem and to factor in other cardiac structures prior to treatment. Usually, post-procedure MRI or echocardiograms will also be requested by the doctor to monitor the success of treatment.
Take necessary medications on time – In some cases, physicians would prescribe medications prior to the procedure. Patients should ensure that these medications are taken regularly, unless otherwise specified by the physician.
Limiting the procedure – Patients who experienced a recent bacterial or fungal infection are usually not allowed to undergo percutaneous closure. This is to limit the spread of microorganisms in the surgical tools.
Allot time for recuperation – While percutaneous closure is minimally invasive, patients would still be required to recuperate for at least 24 hours after the procedure. This will allow for further monitoring and evaluation of cardiac activities post-treatment.
Risk factors – Physicians greatly consider cardiovascular risk factors in intervening using percutaneous closure. In patients with a risk for such diseases, additional screening procedures (such as coronary angiogram) may be performed prior to treatment.

Procedure for Percutaneous Closure

A percutaneous closure is done under local anesthesia and usually takes approximately one to two hours to complete. Below is a detailed process of a typical percutaneous closure directed at treating ASD or PFO.

After pre-intervention preparations have been completed, a physician would start the treatment by inducing local anesthesia or analgosedation into the patient - particularly in the patient’s femoral vein where catheterization will also take place.
The physician would then insert a catheter within the femoral vein. Through echocardiographic and fluoroscopic guidance, the device travels from the femoral area into the heart.
Before entering the heart through the left atrium, medication such as intravenous heparine may be injected. After this process, the ASD size shall be determined.
The device size is dependent on the diameter size of the ASD; as such, the specific device to be used shall be determined only after the actual ASD has been screened.
A sheath will be positioned near the target area (which is usually left atrium near the pulmonary vein). The device will be deployed through this sheath through echocardiographic guidance.
After confirming a secure position through a pull-and-push technique, the device will be released from the sheath, and its final position will be monitored and documented through the aforementioned screening instruments.

The simplicity of a percutaneous closure procedure enables physicians to treat both children and adults with ASD or PFO with ease. With high success rates, the procedure is widely-utilized globally in treating such conditions.