title: A new "tool" for transcatheter atrial defect closure: the St. Jude SL2™ sheath.
abstract: BACKGROUND
  Orienting the left atrial disc of an atrial septal defect (ASD) closure device parallel to the septum is important, particularly in cases of ASD with deficient retroaortic rim. Standard vascular sheaths can make this challenging. We report the use of an electrophysiologic sheath, the SL2™ St. Jude Vascular sheath (St. Jude Medical, St. Paul, MN) for closure of ASD.
  
  
  METHODS
  All patients undergoing ASD closure between July 2010 and February 2011 at The Children's Hospital at Montefiore in which the SL2 sheath was used were reviewed.
  
  
  RESULTS
  Nine patients underwent transcatheter ASD or PFO (1/9) closure with the SL2 sheath. Mean age was 22.7 years (range, 3-58); weight was 46.5 kg (range, 14.7-78.6). The Amplatzer ASD Occluder (AGA Medical Corp., Plymouth, MN) was used in all cases. The mean measurement of the ASDs via "stop-flow" technique was 13.3 mm (range, 4-19). The mean device size was 13.9 mm (range, 5-20) or 105% the size of the defect. The retroaortic rim was deficient (<2 mm) in 3 of 9. ASD closure was achieved in 9 of 9. In all, the left atrial disk was brought toward the atrial septum parallel to the atrial septum, and repositioning or recapturing of the device was unnecessary in any case. Mean fluoroscopy time was 9.3 min (range, 2.2-18). No significant complications.
  
  
  CONCLUSIONS
  The SL2 sheath was useful to position the ASD device parallel to the atrial septum, eliminating the need for redeployment during the procedure. This sheath was useful in those cases of deficient retroaortic rim in this study.
authors.affiliation: Pediatric Interventional Cardiology-Division of Pediatric Cardiology, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Lee
authors.forename: Nicole
authors.initials: N
authors.lastname: Sutton
authors.forename: Leo
authors.initials: L
authors.lastname: Lopez
authors.forename: Kanwal
authors.initials: K
authors.lastname: Farooqi
authors.forename: Joseph
authors.initials: J
authors.lastname: Mahgerefteh
authors.forename: Imelissa
authors.initials: I
authors.lastname: Blancas
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D062906:Cardiac Catheters; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012189:Retrospective Studies; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult