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Letter to the Editor
Residual shunt due to spontaneous perforation of polyvinyl alcohol membrane of ASD Occluder; what about after diagnosis?
Shunt residual devido a perfuração espontânea da membrana de álcool polivinílico de um dispositivo de encerramento de CIA. O que sucede após o diagnóstico?
Serdar Bozyelça,
Autor para correspondência
seribra85@gmail.com

Corresponding author.
, Tayfun Sahinb
a University of Health Sciences, Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
b Kocaeli University School of Medicine, Department of Cardiology, Kocaeli, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the article &#8220;Successful percutaneous closure of a residual atrial septal defect due to device failure&#8221; written by S&#46; Aguiar Rosa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> with great interest&#46; We congratulate the authors for nice three-dimensional echocardiographic images and successful management of the device failure&#46; We also used the CARDIA Ultrasept&#8482; ASD device in 9 patients in our center and three of them became defective after 19 to 25 months&#44; causing significant shunts through the device frame and requiring repeat procedures&#46; We recently reported a patient with a massive shunt due to spontaneous perforation of an Ultrasept&#8482; Occluder polyvinyl alcohol &#40;PVA&#41; membrane&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Based on our experience and the many cases reported with different versions of the Ultrasept&#8482; prostheses&#44; and considering the possibility of unnoticed and unreported failures&#44; we would like to point out that we do not completely agree with the statement&#44; &#8220;Although the use of this material &#40;PVA membrane&#41; in ASD closure devices is generally successful&#8230;&#8221;&#44; in the discussion section&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The treatment options are surgical removal of the failing device and repair with a patch and covering of the damaged membrane with a second device&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> The authors chose the second option and occluded the defect successfully with a 20-mm Ultrasept&#8482; PFO device&#46; We would also like to mention a few issues about the &#8220;device-in-device technique&#8221; preferred by the authors&#46; Nobody&#44; either previous authors&#44; including ourselves&#44; or the manufacturer&#44; has been able to explain the mechanism of PVA membrane disappearance&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> Moreover&#44; to our knowledge&#44; Ultrasept&#8482; PFO devices are also covered with a PVA membrane&#46; Surgical repair might therefore be preferable because of the uncertain mechanism of the malfunction&#46; In view of the many risks involved in open heart surgery and taking patient preference into account&#44; the second-device technique can obviously be used&#46; However&#44; a device with a different structure should be chosen to avoid possible recurrence of inadequate endothelialization&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Informação do artigo
ISSN: 08702551
Idioma original: Inglês
DOI:10.1016/j.repc.2017.11.012
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