Transcatheter closure of atrial septal defect using fully biodegradable occluder under ultrasound guidance: A case report_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Ying'ao ¹ , YAN Yiming ¹ , LI Ziping ¹ , LI Hang ¹ , ZHANG Fengwen ¹ , FANG Fang ¹ , ZHAO Guangzhi ¹ , DONG Jing ¹ , WANG Chuangshi ¹ , WANG Jiande ² ,  OUYANG Wenbin ¹ ,  PAN Xiangbin ¹

1. Department of Structural Heart Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, State Key Laboratory of Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, National Clinical Research Center for Cardiovascular Diseases, Beijing, 100037, P. R. China;
2. Ultrasound Department, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding?author：

OUYANG Wenbin, Email: droywb31@163.com; PAN Xiangbin, Email: panxiangbin@fuwaihospital.org

Keywords：

Atrial septal defect; fully biodegradable occluder; echocardiography; transcatheter intervention

DOI：

10.7507/1007-4848.202312032

Video：

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Currently, transcatheter intervention is the preferred treatment for patients with anatomically suitable atrial septal defects. However, the use of nickel-titanium alloy occluders in interventional procedures results in lifelong presence of the implant in the body, leading to complications such as metal allergies and arrhythmias in some patients. To overcome the short-term and long-term complications associated with the presence of metal, and to avoid radiation exposure and metal toxicity, this paper reports a case of successful transcatheter closure of atrial septal defect in a pediatric patient with metal allergies using fully biodegradable occluder under ultrasound guidance, achieving excellent results by interventional therapy.

Citation： ZHAO Ying'ao, YAN Yiming, LI Ziping, LI Hang, ZHANG Fengwen, FANG Fang, ZHAO Guangzhi, DONG Jing, WANG Chuangshi, WANG Jiande, OUYANG Wenbin, PAN Xiangbin. Transcatheter closure of atrial septal defect using fully biodegradable occluder under ultrasound guidance: A case report. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(12): 1801-1804. doi: 10.7507/1007-4848.202312032 Copy

1.	Sadasivan Nair P, Jaya JS, Comella A, et al. Migraine-like headaches associated with nickel allergy requiring removal of atrial septal defect closure device. Indian J Thorac Cardiovasc Surg, 2021, 37(3): 299-302.
2.	Mullen MJ, Hildick-Smith D, De Giovanni JV, et al. BioSTAR evaluation study (BEST): a prospective, multicenter, phase Ⅰ clinical trial to evaluate the feasibility, efficacy, and safety of the BioSTAR bioabsorbable septal repair implant for the closure of atrial-level shunts. Circulation, 2006, 114(18): 1962-1967.
3.	Shi D, Kang Y, Zhang G, et al. Biodegradable atrial septal defect occluders: a current review. Acta Biomater, 2019, 96: 68-80.
4.	Rao PS, Harris AD. Recent advances in managing septal defects: atrial septal defects. F1000Res, 2017, 6: 2042.
5.	Butera G, De Rosa G, Chessa M, et al. Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol, 2003, 42(2): 241-245.
6.	King TD, Thompson SL, Steiner C, et al. Secundum atrial septal defect: nonoperative closure during cardiac catheterization. JAMA, 1976, 235(23): 2506-2509.
7.	國家衛生健康委員會國家結構性心臟病介入質量控制中心, 國家心血管病中心結構性心臟病介入質量控制中心, 中華醫學會心血管病學分會先心病經皮介入治療指南工作組, 等. 常見先天性心臟病經皮介入治療指南(2021版). 中華醫學雜志, 2021, 101(38): 3054-3076.National Quality Control Center for Intervention of Structural Heart Diseases of National Health Commission, National Quality Control Center for Intervention of Structural Heart Diseases of National Center for Cardiovascular Diseases, Chinese Society of Cardiology, et al. Guideline for percutaneous interventional therapy of common congenital heart diseases (2021 edition). Natl Med J China, 2021, 101(38): 3054-3076.
8.	Agarwal S, Bajaj NS, Kumbhani DJ, et al. Meta-analysis of transcatheter closure versus medical therapy for patent foramen ovale in prevention of recurrent neurological events after presumed paradoxical embolism. JACC Cardiovasc Interv, 2012, 5(7): 777-789.
9.	Huynh K. Antiplatelet therapy: clopidogrel plus aspirin reduces migrane attacks after ASD closure. Nat Rev Cardiol, 2016, 13(1): 2.
10.	施浩, 潘湘斌, 王首正, 等. 單純超聲引導下經頸靜脈途徑封堵嬰幼兒房間隔缺損臨床療效. 中國胸心血管外科臨床雜志, 2020, 27(6): 645-648.Shi H, Pan XB, Wang SZ, et al. Clinical efficacy of transjugular device closure of atrial septal defect in infants and young children guided solely by echocardiography. Chin J Thorac Cardiovasc Surg, 2020, 27(6): 645-648.
11.	潘湘斌. 超聲引導經皮介入治療結構性心臟病的探索和發展前景. 中國胸心血管外科臨床雜志, 2018, 25(5): 359-361.Pan XB. Exploration and prospect of ultrasound-guided percutaneous interventional therapy for structural heart disease. Chin J Thorac Cardiovasc Surg, 2018, 25(5): 359-361.
12.	潘湘斌, 逄坤靜, 歐陽文斌, 等. 單純超聲心動圖引導下經皮室間隔缺損封堵術的應用研究. 中國循環雜志, 2015, 30(8): 774-776.Pan XB, Pang KJ, Ouyang WB, et al. Application of percutaneous closure of ventricular septal defect guided solely by transthoracic echocardiography. Chin Circ J, 2015, 30(8): 774-776.
13.	Kong P, Zhao G, Zhang Z, et al. Novel panna guide wire facilitates percutaneous and nonfluoroscopic procedure for atrial septal defect closure: a randomized controlled trial. Circ Cardiovasc Interv, 2020, 13(9): e009281.
14.	高漫辰, 段福建, 張戈軍, 等. 經導管緣對緣修復技術初步實踐: MitraClip治療二尖瓣反流多中心早期結果. 中國胸心血管外科臨床雜志, 2022, 29(5): 547-552.Gao MC, Duan FJ, Zhang GJ, et al. Preliminary practice of transcatheter edge-to-edge repair technique: early multi-center results of MitraClip for mitral regurgitation. Chin J Thorac Cardiovasc Surg, 2022, 29(5): 547-552.
15.	李文超, 李健, 歐陽文斌, 等. 單純經胸超聲心動圖引導經皮介入治療復雜房間隔缺損的臨床療效. 中國循環雜志, 2023, 38(8): 820-825.Li WC, Li J, Ouyang WB, et al. Clinical efficacy of percutaneous interventional therapy for complex atrial septal defect guided solely by transthoracic echocardiography. Chin Circ J, 2023, 38(8): 820-825.
16.	Wang S, Li Z, Wang Y, et al. Transcatheter closure of perimembranous ventricular septal defect using a novel fully bioabsorbable occluder: multicenter randomized controlled trial. Sci Bull (Beijing), 2023, 68(10): 1051-1059.
17.	Kong P, Liu X, Li Z, et al. Biodegradable cardiac occluder with surface modification by gelatin-peptide conjugate to promote endogenous tissue regeneration. Adv Sci (Weinh), 2023: e2305967.

1. Sadasivan Nair P, Jaya JS, Comella A, et al. Migraine-like headaches associated with nickel allergy requiring removal of atrial septal defect closure device. Indian J Thorac Cardiovasc Surg, 2021, 37(3): 299-302.
2. Mullen MJ, Hildick-Smith D, De Giovanni JV, et al. BioSTAR evaluation study (BEST): a prospective, multicenter, phase Ⅰ clinical trial to evaluate the feasibility, efficacy, and safety of the BioSTAR bioabsorbable septal repair implant for the closure of atrial-level shunts. Circulation, 2006, 114(18): 1962-1967.
3. Shi D, Kang Y, Zhang G, et al. Biodegradable atrial septal defect occluders: a current review. Acta Biomater, 2019, 96: 68-80.
4. Rao PS, Harris AD. Recent advances in managing septal defects: atrial septal defects. F1000Res, 2017, 6: 2042.
5. Butera G, De Rosa G, Chessa M, et al. Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol, 2003, 42(2): 241-245.
6. King TD, Thompson SL, Steiner C, et al. Secundum atrial septal defect: nonoperative closure during cardiac catheterization. JAMA, 1976, 235(23): 2506-2509.
7. 國家衛生健康委員會國家結構性心臟病介入質量控制中心, 國家心血管病中心結構性心臟病介入質量控制中心, 中華醫學會心血管病學分會先心病經皮介入治療指南工作組, 等. 常見先天性心臟病經皮介入治療指南(2021版). 中華醫學雜志, 2021, 101(38): 3054-3076.National Quality Control Center for Intervention of Structural Heart Diseases of National Health Commission, National Quality Control Center for Intervention of Structural Heart Diseases of National Center for Cardiovascular Diseases, Chinese Society of Cardiology, et al. Guideline for percutaneous interventional therapy of common congenital heart diseases (2021 edition). Natl Med J China, 2021, 101(38): 3054-3076.
8. Agarwal S, Bajaj NS, Kumbhani DJ, et al. Meta-analysis of transcatheter closure versus medical therapy for patent foramen ovale in prevention of recurrent neurological events after presumed paradoxical embolism. JACC Cardiovasc Interv, 2012, 5(7): 777-789.
9. Huynh K. Antiplatelet therapy: clopidogrel plus aspirin reduces migrane attacks after ASD closure. Nat Rev Cardiol, 2016, 13(1): 2.
10. 施浩, 潘湘斌, 王首正, 等. 單純超聲引導下經頸靜脈途徑封堵嬰幼兒房間隔缺損臨床療效. 中國胸心血管外科臨床雜志, 2020, 27(6): 645-648.Shi H, Pan XB, Wang SZ, et al. Clinical efficacy of transjugular device closure of atrial septal defect in infants and young children guided solely by echocardiography. Chin J Thorac Cardiovasc Surg, 2020, 27(6): 645-648.
11. 潘湘斌. 超聲引導經皮介入治療結構性心臟病的探索和發展前景. 中國胸心血管外科臨床雜志, 2018, 25(5): 359-361.Pan XB. Exploration and prospect of ultrasound-guided percutaneous interventional therapy for structural heart disease. Chin J Thorac Cardiovasc Surg, 2018, 25(5): 359-361.
12. 潘湘斌, 逄坤靜, 歐陽文斌, 等. 單純超聲心動圖引導下經皮室間隔缺損封堵術的應用研究. 中國循環雜志, 2015, 30(8): 774-776.Pan XB, Pang KJ, Ouyang WB, et al. Application of percutaneous closure of ventricular septal defect guided solely by transthoracic echocardiography. Chin Circ J, 2015, 30(8): 774-776.
13. Kong P, Zhao G, Zhang Z, et al. Novel panna guide wire facilitates percutaneous and nonfluoroscopic procedure for atrial septal defect closure: a randomized controlled trial. Circ Cardiovasc Interv, 2020, 13(9): e009281.
14. 高漫辰, 段福建, 張戈軍, 等. 經導管緣對緣修復技術初步實踐: MitraClip治療二尖瓣反流多中心早期結果. 中國胸心血管外科臨床雜志, 2022, 29(5): 547-552.Gao MC, Duan FJ, Zhang GJ, et al. Preliminary practice of transcatheter edge-to-edge repair technique: early multi-center results of MitraClip for mitral regurgitation. Chin J Thorac Cardiovasc Surg, 2022, 29(5): 547-552.
15. 李文超, 李健, 歐陽文斌, 等. 單純經胸超聲心動圖引導經皮介入治療復雜房間隔缺損的臨床療效. 中國循環雜志, 2023, 38(8): 820-825.Li WC, Li J, Ouyang WB, et al. Clinical efficacy of percutaneous interventional therapy for complex atrial septal defect guided solely by transthoracic echocardiography. Chin Circ J, 2023, 38(8): 820-825.
16. Wang S, Li Z, Wang Y, et al. Transcatheter closure of perimembranous ventricular septal defect using a novel fully bioabsorbable occluder: multicenter randomized controlled trial. Sci Bull (Beijing), 2023, 68(10): 1051-1059.
17. Kong P, Liu X, Li Z, et al. Biodegradable cardiac occluder with surface modification by gelatin-peptide conjugate to promote endogenous tissue regeneration. Adv Sci (Weinh), 2023: e2305967.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Transcatheter closure of atrial septal defect using fully biodegradable occluder under ultrasound guidance: A case report

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