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Amplatzer Occluder Device
Randy R. Richardson, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Septal occluder device
          • Duct occluder device
        • Definitions

          • Percutaneous, transcatheter occlusion of atrial or ventricular septal defect or vessel
          • Invented by Dr. Kurt Amplatz, radiologist
          • 4 varieties
            • Septal [atrial septal defect (ASD)] occluder
              • FDA approved in 2001
              • Designed to close atrial septal wall on each side of secundum defect
              • Available in 4- to 38-mm sizes in USA
              • Multifenestrated ASD requires cribriform occluder subtype
            • Muscular [ventricular septal defect (VSD)] occluder
              • Designed to close VSD on each side of defect
              • 2 discs are connected together by waist that corresponds to size of VSD
              • Available in 4- to 18-mm waist sizes
            • Duct occluder
              • Designed to seal patent ductus arteriosus (PDA)
              • Conical shape to conform to PDA
              • Available in 5- to 16-mm diameters
            • Vascular plug
              • Used for embolization of peripheral arteries & veins
              • Alternative to coils
          • Device is made from nitinol mesh & polyester fabric, which provide rapid occlusion & substrate for tissue ingrowth
          • Sizing balloon is used to determine correct size device
          • Requires transesophageal or intracardiac echocardiography as well as fluoroscopic imaging during procedure
          • Can be repositioned & recaptured during placement
          • Very high closure rates (> 95%)
          • Indications for ASD closure device
            • Ostium secundum ASD
            • Clinical evidence of right ventricular (RV) volume overload
              • Left-to-right shunt 1.5:1 ≥, or RV chamber enlargement
          • Contraindications
            • Sepsis within 1 month prior to implantation
            • Bleeding disorder or other contraindication to aspirin therapy after device placement
            • Intracardiac thrombi
            • Septal defect location < 5 mm from coronary sinus, atrioventricular valves, or pulmonary vein orifice
            • Nickel allergy (as nitinol contains nickel)
          • Follow-up
            • Requires endocarditis prophylaxis & antiplatelet/anticoagulation therapy for 6 months post implantation
            • Devices are "conditional 6" to 3.0 Tesla magnet

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Angiographic Findings

                    Selected References

                    1. Rao PS: Outcomes of device closure of atrial septal defects. Children (Basel). 7(9), 2020
                    2. Yasuhara J et al: Comparison of transcatheter patent ductus arteriosus closure between children and adults. Heart Vessels. 35(11):1605-13, 2020
                    3. Zhang X et al: Transcatheter closure of atrial septal defects with cardiac computed tomography sizing: eight-year single-center practice. Cardiology. 1-9, 2020
                    4. Jun JH et al: Mitral regurgitation detected during the intraoperative period after atrial septal defect closure: a case report. J Cardiothorac Surg. 14(1):140, 2019
                    5. Kobayashi D et al: Results of the combined U.S. multicenter postapproval study of the Nit-Occlud PDA device for percutaneous closure of patent ductus arteriosus. Catheter Cardiovasc Interv. 93(4):645-51, 2019
                    6. Bhatla P et al: Utility and scope of rapid prototyping in patients with complex muscular ventricular septal defects or double-outlet right ventricle: does it alter management decisions? Pediatr Cardiol. 38(1):103-14, 2017
                    7. Jalal Z et al: Long-term complications after transcatheter atrial septal defect closure: a review of the medical literature. Can J Cardiol. 32(11):1315.e11-8, 2016
                    8. Behjati-Ardakani M et al: Long-term results of transcatheter closure of patent ductus arteriosus in adolescents and adults with Amplatzer duct occluder. N Am J Med Sci. 7(5):208-11, 2015
                    9. Bissessor N: Current perspectives in percutaneous atrial septal defect closure devices. Med Devices (Auckl). 8:297-303, 2015
                    10. Gossett JG et al: Growth of the atrial septum after Amplatzer device closure of atrial septal defects in young children. Catheter Cardiovasc Interv. 86(6):1041-7, 2015
                    11. Saurav A et al: Comparison of percutaneous device closure versus surgical closure of peri-membranous ventricular septal defects: a systematic review and meta-analysis. Catheter Cardiovasc Interv. 86(6):1048-56, 2015
                    12. Lee EY et al: Amplatzer atrial septal defect occluder for pediatric patients: radiographic appearance. Radiology. 233(2):471-6, 2004
                    13. Butera G et al: Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol. 42(2):241-5, 2003
                    14. Kim JH et al: Radiologic findings of 2 commonly used cardiac septal occluders with clinical correlation. J Thorac Imaging. 18(3):183-9, 2003
                    15. Chessa M et al: Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol. 39(6):1061-5, 2002
                    Related Anatomy
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                    Related Differential Diagnoses
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                    References
                    Tables

                    Tables

                    KEY FACTS

                    • Terminology

                      • Imaging

                        • Clinical Issues

                          TERMINOLOGY

                          • Synonyms

                            • Septal occluder device
                            • Duct occluder device
                          • Definitions

                            • Percutaneous, transcatheter occlusion of atrial or ventricular septal defect or vessel
                            • Invented by Dr. Kurt Amplatz, radiologist
                            • 4 varieties
                              • Septal [atrial septal defect (ASD)] occluder
                                • FDA approved in 2001
                                • Designed to close atrial septal wall on each side of secundum defect
                                • Available in 4- to 38-mm sizes in USA
                                • Multifenestrated ASD requires cribriform occluder subtype
                              • Muscular [ventricular septal defect (VSD)] occluder
                                • Designed to close VSD on each side of defect
                                • 2 discs are connected together by waist that corresponds to size of VSD
                                • Available in 4- to 18-mm waist sizes
                              • Duct occluder
                                • Designed to seal patent ductus arteriosus (PDA)
                                • Conical shape to conform to PDA
                                • Available in 5- to 16-mm diameters
                              • Vascular plug
                                • Used for embolization of peripheral arteries & veins
                                • Alternative to coils
                            • Device is made from nitinol mesh & polyester fabric, which provide rapid occlusion & substrate for tissue ingrowth
                            • Sizing balloon is used to determine correct size device
                            • Requires transesophageal or intracardiac echocardiography as well as fluoroscopic imaging during procedure
                            • Can be repositioned & recaptured during placement
                            • Very high closure rates (> 95%)
                            • Indications for ASD closure device
                              • Ostium secundum ASD
                              • Clinical evidence of right ventricular (RV) volume overload
                                • Left-to-right shunt 1.5:1 ≥, or RV chamber enlargement
                            • Contraindications
                              • Sepsis within 1 month prior to implantation
                              • Bleeding disorder or other contraindication to aspirin therapy after device placement
                              • Intracardiac thrombi
                              • Septal defect location < 5 mm from coronary sinus, atrioventricular valves, or pulmonary vein orifice
                              • Nickel allergy (as nitinol contains nickel)
                            • Follow-up
                              • Requires endocarditis prophylaxis & antiplatelet/anticoagulation therapy for 6 months post implantation
                              • Devices are "conditional 6" to 3.0 Tesla magnet

                          IMAGING

                          • General Features

                            • Radiographic Findings

                              • CT Findings

                                • MR Findings

                                  • Ultrasonographic Findings

                                    • Angiographic Findings

                                      Selected References

                                      1. Rao PS: Outcomes of device closure of atrial septal defects. Children (Basel). 7(9), 2020
                                      2. Yasuhara J et al: Comparison of transcatheter patent ductus arteriosus closure between children and adults. Heart Vessels. 35(11):1605-13, 2020
                                      3. Zhang X et al: Transcatheter closure of atrial septal defects with cardiac computed tomography sizing: eight-year single-center practice. Cardiology. 1-9, 2020
                                      4. Jun JH et al: Mitral regurgitation detected during the intraoperative period after atrial septal defect closure: a case report. J Cardiothorac Surg. 14(1):140, 2019
                                      5. Kobayashi D et al: Results of the combined U.S. multicenter postapproval study of the Nit-Occlud PDA device for percutaneous closure of patent ductus arteriosus. Catheter Cardiovasc Interv. 93(4):645-51, 2019
                                      6. Bhatla P et al: Utility and scope of rapid prototyping in patients with complex muscular ventricular septal defects or double-outlet right ventricle: does it alter management decisions? Pediatr Cardiol. 38(1):103-14, 2017
                                      7. Jalal Z et al: Long-term complications after transcatheter atrial septal defect closure: a review of the medical literature. Can J Cardiol. 32(11):1315.e11-8, 2016
                                      8. Behjati-Ardakani M et al: Long-term results of transcatheter closure of patent ductus arteriosus in adolescents and adults with Amplatzer duct occluder. N Am J Med Sci. 7(5):208-11, 2015
                                      9. Bissessor N: Current perspectives in percutaneous atrial septal defect closure devices. Med Devices (Auckl). 8:297-303, 2015
                                      10. Gossett JG et al: Growth of the atrial septum after Amplatzer device closure of atrial septal defects in young children. Catheter Cardiovasc Interv. 86(6):1041-7, 2015
                                      11. Saurav A et al: Comparison of percutaneous device closure versus surgical closure of peri-membranous ventricular septal defects: a systematic review and meta-analysis. Catheter Cardiovasc Interv. 86(6):1048-56, 2015
                                      12. Lee EY et al: Amplatzer atrial septal defect occluder for pediatric patients: radiographic appearance. Radiology. 233(2):471-6, 2004
                                      13. Butera G et al: Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol. 42(2):241-5, 2003
                                      14. Kim JH et al: Radiologic findings of 2 commonly used cardiac septal occluders with clinical correlation. J Thorac Imaging. 18(3):183-9, 2003
                                      15. Chessa M et al: Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol. 39(6):1061-5, 2002