title: Novel delivery technique for atrial septal defect closure in young children utilizing the GORE®CARDIOFORM®septal occluder.
abstract: OBJECTIVE
  To develop a novel delivery technique to overcome vascular size limitations for device closure of a secundum ASD in the young patient.
  
  
  BACKGROUND
  The efficacy, clinical utility, and safety of transcatheter closure in comparison to surgical closure are well established; however, access vessel size remains a potential limitation to device selection in the young patient.
  
  
  METHODS
  A retrospective medical record review of all cases of secundum ASD closure between April 2015 and April 2016 utilizing a novel delivery method described herein at two separate academic institutions. The device is disassembled allowing the delivery sheath to serve as the introducer. It is advanced to the RA with re-introduction of the device allowing for deployment in the standard fashion.
  
  
  RESULTS
  Overall, 10 patients underwent secundum ASD closure via this novel delivery technique. There were six females (60%) and the average age at time of the procedure was 4.2 years ± 1.6 years (range 2-6 years). The majority of patients had an isolated secundum ASD (70%) with the primary indication for closure being right ventricular volume overload (90%). All patients had successful placement of a GORE®CARDIOFORM®Septal Occluder (GCSO) with no or trivial residual shunt. No patients had vascular complications related to the procedure.
  
  
  CONCLUSIONS
  We describe a novel technique for ASD closure using the GCSO delivery sheath as the access sheath, which reduces the vascular access size requirement by 25%, thus addressing one common limitation for percutaneous device closure of a secundum ASD in young patients. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jason H
authors.identifier: http://orcid.org/0000-0002-3941-0707
authors.initials: JH
authors.lastname: Anderson
authors.affiliation: Department of Pediatric Medicine/Division of Pediatric Cardiology, UCSF School of Medicine, San Francisco, California.
authors.forename: Hannah
authors.initials: H
authors.lastname: Fraint
authors.affiliation: Department of Pediatric Medicine/Division of Pediatric Cardiology, UCSF School of Medicine, San Francisco, California.
authors.forename: Phillip
authors.initials: P
authors.lastname: Moore
authors.affiliation: Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Allison K
authors.initials: AK
authors.lastname: Cabalka
authors.affiliation: Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Nathaniel W
authors.initials: NW
authors.lastname: Taggart
mesh_terms: D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008499:Medical Records; D008910:Minnesota; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome
keywords: endovascular procedures; septal occluder device