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Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(1):16-20; doi:10.1093/bjaceaccp/mkm046
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Anaesthesia for percutaneous closure of atrial septal defects

Patrick A. Calvert, BCh MA MRCP
SpR in Cardiology
Papworth Hospital
Papworth Everard
Cambridge CB23 8RE
UK

Andrew A. Klein, MBBS FRCA
Consultant in Anaesthesia and Critical care
Papworth Hospital
Papworth Everard
Cambridge CB23 8RE
UK
E-mail: andrew.klein@papworth.nhs.uk

Key Words: Percutaneous closure is the procedure of choice for the majority of patients with atrial septal defects and symptomatic patent foramen ovale (PFO). • Closure of an ostium secundum atrial septal defect will prevent pulmonary hypertension due to left to right shunt and improves life expectancy. • Cerebrovascular accident or transient cerebral event is an indication for closure of a PFO, as paradoxical embolus may be the cause. • General anaesthesia is usually required, along with trans-oesophageal echocardiography; day case management is safe and cost-effective. • Permanent complications are very rare, and patient satisfaction is high.

The first 150 words of the full text of this article appear below.

Interventional cardiology has undergone considerable advances in device technology over the past 20 yr. Anaesthesia or sedation is required for a number of these procedures as pain or general discomfort is frequently a feature coupled with the requirement to lie supine and still for up to 1 h or more. Percutaneous atrial septal occlusion is a well developed and commonly performed intervention. Trans-oesophageal echocardiography (TOE) is required as a part of the procedure, which is most often carried out in the catheter lab under general anaesthesia. Percutaneous closure avoids the need for surgery and sternotomy, and is thus associated with significantly fewer complications and greater patient satisfaction.


   Indications
 
The established indications for atrial septal occlusion are closure of an ostium secundum atrial septal defect (ASD) to prevent shunting of blood from the left to right atrium, and cryptogenic stroke or decompression illness secondary to a patent foramen ovale (PFO). Although ASD . . . [Full Text of this Article]

Septal closure for shunt: ASD

Septal closure for cryptogenic stroke

Septal closure for decompression illness


   Preoperative investigations
 

   Choice of device
 

   Anaesthetic management
 

   Placement of septal occlusion device
 

   Postoperative care
 

   Complications
 

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