Procedural, Early and Long-term Outcomes after Percutaneous Closure of Atrial Septal Defect: Comparison between Large and Very Large Atrial Septal Defect Groups

Abstract

BackgroundThis study aimed to compare procedural, early and long-term outcome of device closure of atrial septal defect (ASD) between large ASD patients and very large ASD patients.MethodsWe carried a retrospective study of adult large ASD (defined as ≥25 mm) treated by percutaneous closure using Amplatzer septal occluder during 12-year period (May 2003–February 2015) at a single tertiary center. A total of 269 patients were divided into 2 groups, according to the pre-procedural maximal ASD diameter; 25 mm≤ASD<35mm, group 1 (n=216) and 35 mm≤ASD, group 2 (n=53). We compared procedural parameters, early complications and long-term follow-up results between 2 groups.ResultsThe need of modified implantation techniques (MITs) was higher group 2 (23.6% vs. 37.7%, p=0.034). Procedural success rate was considerably high in both groups (99.1% in group 1 vs. 100% in group 2, p=0.620). Major complications were occurred in 4 (1.5%) patients (1.4% vs. 1.9%, p=0.804). Minor complication rate was not different between 2 groups. During long-term follow-up (47.2±32.0 months, range, 6.0–135.5), there was one major complication (0.4%) of stroke. Most common long-term minor event was migraine headache (3.9%) followed by arrhythmias (1.9%) without statistical difference between 2 groups.ConclusionsAlthough MIT was more frequently required in very large ASD groups, the procedural, early and long-term outcomes after percutaneous ASD closure were similar in both groups. This suggested that percutaneous ASD closure for very large ASD could be considered a good treatment option.

Procedural, Early and Long-Term Outcomes after Transcatheter Atrial Septal Defects Closure: Comparison between Large and Very Large Atrial Septal Defect Groups

“…In addition, ICE can decrease the needs for endotracheal intubation and general anesthesia during the procedure. In this point, the authors6) of this study showed excellent early and long-term outcome of ICE-guided closure of ASD. However, this technique requires the interventionist to have enough experiences and capability to interpret the ICE images.…”

“…However, usually ASDs more than 20 mm in adults have been considered as large ASD 4)5). In this study, the authors6) used more strict definition of large ASD that the defect is more than 25 mm but showed excellent outcome. It means that the size is not matter except very large ASDs (more than 40 mm) but the adjacent rim anatomy is concern.…”

Association between the Use of Diuretics and Size Reduction in Pediatric Atrial Septal Defect

“… 9) 10) The prevalence rate of complications is favorable, as it is 1% in the case of transcatheter ASD closure. 11) 12) 13) Accordingly, transcatheter secundum ASD closure is preferred over surgery and is being attempted at a younger age; 2) 14) 15) 16) however, recent studies reported both lower periprocedural success rates and an increased risk of periprocedural and long-term complications with the use of transcatheter closure either when body weight is ≤15 kg or in the presence of a large secundum ASD (≥20 mm/m 2 ). 11) 17) 18) Therefore, for improved procedural success rates and reduced complication rates, it is reasonable to delay the procedure until the weight is approximately 15 kg.…”

The Use of Diuretics on Atrial Septal Defect: To Use or Not to Use

“…Of course, there are recent reports for transcatheter closure of ASD that showed excellent short and long-term results in less than 2 years old and 10 kg patients. 7) 8) That is, meticulous evaluation of morphology for ASD and its adjacent structure, well-prepared and delicate procedure, and some special techniques as like balloon-assisted or pulmonary vein technique can make the transcatheter closure safe and feasible in early childhood.…”