Hyung Seok Cho, M.D., Jin Hyoung Kim, M.D., Ph.D., Doh Lee, M.D., Ph.D.
Percutaneous Closure of Patent Foramen Ovale Sponsors: Kung Ming Jan, M.D., Ph.D. Judah Weinberger,...
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Transcript of Percutaneous Closure of Patent Foramen Ovale Sponsors: Kung Ming Jan, M.D., Ph.D. Judah Weinberger,...
Percutaneous Closure Percutaneous Closure of Patent Foramen of Patent Foramen
OvaleOvale
Sponsors:Sponsors:Kung Ming Jan, M.D., Ph.D.Kung Ming Jan, M.D., Ph.D.Judah Weinberger, M.D., Ph.D.Judah Weinberger, M.D., Ph.D.Columbia University Medical CenterColumbia University Medical Center
Department of CardiologyDepartment of Cardiology
Project TA: Jeffrey Garanich, Ph.D. Project TA: Jeffrey Garanich, Ph.D.
Design Team:Ali SternDmitry OulianovDolores MirandaHenry QaziSafiya Arif
The City College of New York / Department of Biomedical Engineering
Prenatal Prenatal oxygenation of oxygenation of blood bypasses blood bypasses lungs.lungs.
Oxygenated blood Oxygenated blood passes from right passes from right to left atrium to left atrium through the through the foramen ovale foramen ovale (FO).(FO).
Fetal circulation
Fetal CirculationFetal Circulation
•Septum primum and secundum overlap.
•Septa create an opening to allow direct shunting of fetal blood.
Prenatal Septal Prenatal Septal DevelopmentDevelopment
Following birth the P of Following birth the P of each chamber changes.each chamber changes.
P changes force septum P changes force septum primum to close over primum to close over septum secundum.septum secundum.
In a period of 1-2 weeks In a period of 1-2 weeks 70% of population have 70% of population have fusion of septa primum fusion of septa primum and secundum.and secundum.
Neonatal Septal Neonatal Septal DevelopmentDevelopment
The condition in which The condition in which the septa fail to seal the septa fail to seal over and remain over and remain patent is known as patent is known as ASD. ASD.
ASD is an opening ASD is an opening (hole) between right (hole) between right and left atria. and left atria.
Atrial Septal DefectAtrial Septal Defect
Patent Foramen OvalePatent Foramen Ovale
PFO, a type of PFO, a type of ASD, is a flap-ASD, is a flap-like opening like opening between the between the atrial septa atrial septa primum and primum and secundumsecundum
Clinical NeedClinical Need
PFO is present in 20-25% of PFO is present in 20-25% of the populationthe population
PFO has been associated PFO has been associated with:with: MigrainesMigraines Cryptogenic strokes Cryptogenic strokes Systemic embolismSystemic embolism
Migraine is a vascular headacheMigraine is a vascular headache Over 2,500,000 people in the U.S. have at Over 2,500,000 people in the U.S. have at
least one migraine weekly, with a lifetime least one migraine weekly, with a lifetime prevalence of 18%prevalence of 18%
PFO are related to Migraines if paradoxic PFO are related to Migraines if paradoxic embolism causes headacheembolism causes headache
MigraineMigraine
Cryptogenic strokesCryptogenic strokes
There are 700,000 strokes per year in the There are 700,000 strokes per year in the U.S.U.S.
30-40% of these are cryptogenic30-40% of these are cryptogenic
40-70% of cryptogenic strokes are PFO 40-70% of cryptogenic strokes are PFO relatedrelated
84,000-196,000 strokes per year in the 84,000-196,000 strokes per year in the United States are by paradoxical embolism United States are by paradoxical embolism due to PFOdue to PFO
Treatment OptionsTreatment Options
Medical TreatmentMedical Treatment
Open heart Open heart surgery to close surgery to close the PFO the PFO
Percuteneous Percuteneous closure of the PFOclosure of the PFO
CardioSealCardioSeal
2 Double 2 Double Umbrella Umbrella implantimplant
MP35N MP35N FrameworkFramework
Dacron Dacron Sizes: 17-33mmSizes: 17-33mm
AmplazterAmplazter
Self Self expandableexpandable
Short Short connecting connecting waistwaist
Nitinol WiresNitinol Wires Sizes: 4-38mmSizes: 4-38mm
DisadvantagesDisadvantages
Designed for ASDDesigned for ASD Large surface AreaLarge surface Area Thrombus formation Thrombus formation Reduced Reduced
Endothelialization Endothelialization Poor AppositionPoor Apposition Device FractureDevice Fracture Device EmbolizationDevice Embolization
Seals PFO only Consists of two components
Delivery unit Means of closure
Size requirements Delivery size: 3 - 4 mm diameter Deployment size: 3.6 x 4.2 cm Seals area of 8 mm radius around PFO
Biocompatibility Immunological response Thrombogenic response
Single use
Required SpecificationsRequired Specifications
Electrical isolation Isolate main voltage source
Prevent current leakage
Current limits Direct current < 1 μA
Alternating current < 0.4 μA
Mechanical forces
Structural flexibility
Mechanical & Electrical Mechanical & Electrical StabilityStability
Easily operable
Cost efficient
Biodegradable
Degradation time
Particle size
Visible by ultrasound
Non-magnetic
Desired SpecificationsDesired Specifications
In Vitro Reaction to environment
Fatigue test
Maneuverability
Catheter-device integrity
In Vivo*
Dog testing
Human testing
*Evaluation may not be performed in the scope of the project
Device EvaluationDevice Evaluation
ConceptsConcepts
Glue or collagen plugsGlue or collagen plugs Magnetic suturingMagnetic suturing Energy welding devicesEnergy welding devices Staple pins/suturesStaple pins/sutures ScaffoldScaffold Clipping deviceClipping device Intra atrium deviceIntra atrium device Coiled suturing deviceCoiled suturing device ““Sutura” modelSutura” model
Hooked Scaffold ImplantHooked Scaffold Implant
Polyester scaffold Polyester scaffold Advantages:Advantages:
Material Degradation into Material Degradation into H2O & CO2H2O & CO2
Disadvantages :Disadvantages : Material: too stiff for Material: too stiff for
deliverydelivery
Intra atrium device (IAD)Intra atrium device (IAD)
Advantages:Advantages: Minimal amount of Minimal amount of
foreign material in the foreign material in the bodybody
Does not require exact Does not require exact positioningpositioning
Disadvantages:Disadvantages: Material selection:Material selection: Complicated knot Complicated knot
delivery methoddelivery method
Coiled needleCoiled needle
Components: coiled Components: coiled needle, 16mm base needle, 16mm base unitunit
Advantages:Advantages: Does not require exact Does not require exact
positioningpositioning Disadvantages:Disadvantages:
Complicated mechanicsComplicated mechanics Requires electrical Requires electrical
energyenergy Complicated knot Complicated knot
delivery methoddelivery method
Sutura ModelSutura Model Suturing deviceSuturing device
Components: 2 retractable arms, Components: 2 retractable arms, thread attached, 2 needles, handlethread attached, 2 needles, handle
Advantages:Advantages: Existing device provides successful Existing device provides successful
mechanismmechanism Disadvantages:Disadvantages:
Complicated manufacturing Complicated manufacturing
Clipping DeviceClipping Device
Advantages:Advantages: Procedure using the Procedure using the
device is reversible device is reversible in case of failurein case of failure
Simple deployment Simple deployment mechanismmechanism
Disadvantages:Disadvantages: Requires precisionRequires precision Material propertiesMaterial properties
AcknowledgementsAcknowledgements
Kung Ming Jan, M.D., Ph.D.Kung Ming Jan, M.D., Ph.D. Judah Weinberger, M.D., Ph.D.Judah Weinberger, M.D., Ph.D. Columbia University Medical CenterColumbia University Medical Center Department of CardiologyDepartment of Cardiology
Project TA: Jeffrey Garanich, Ph.D. Project TA: Jeffrey Garanich, Ph.D. Robert Sommer, M.D., Ph.D.Robert Sommer, M.D., Ph.D.