Single pediatric center experience with multiple device implantation for complex secundum atrial septal defects

Abstract

Objectives: We analyzed the efficacy and complications of placing multiple transcatheter devices to correct complex ASD in a primarily pediatric population. Background: Limited pediatric information exists regarding the safety and efficacy of using multiple devices for secundum atrial septal defects (ASD) when multiple defects are present. Methods: Cath lab, echo, and clinical data were reviewed for 238 patients who underwent device closure of secundum ASD from 2000 to 2007 at a single pediatric center. Of those requiring multiple devices (n 5 15), residual shunting and complications were assessed. Results: 238 patients (mean age 12 yrs; 80% < 16 yrs) underwent transcatheter ASD closure. 34 (14%) had multiple ASD, but only 15 received multiple devices (2 devices in 14 and 3 devices in 1). The mean age and weight (12 yrs; 35 kg) represent a younger population than previously reported. Only 3 were > 15 yrs, with a median age of 10.8 yrs (range 2-31). There was no compromise or obstruction to surrounding structures, and no device embolization or erosion was noted. A tiny thrombus was observed on the right sided screw of one device with no clinical sequelae. One patient (age 31 yrs) died at home 30 days post procedure from cardiac tamponade. Autopsy revealed the 3 intact devices in stable position without evidence of erosion. Latest available echo follow-up for the group revealed functional resolution of atrial level shunting in all patients. Conclusion: Multiple devices can safely and effectively be implanted in the pediatric population to close complex ASD. '

Transcatheter Closure of Multiple Atrial Septal Defects With the Amplatzer Device

“…The Amplatzer septal occluder (AGA medical Corp, Golden Valley, MN, USA) has been proven to be as effective as surgical closure, with the added benefit of shorter hospital stay 2). Multiple or fenestrated ASDs that require closure are not uncommon,3) and there are reports on transcatheter closure by using multiple devices 4-6). We herein report our experience with transcatheter closure of multiple ASDs by using the Amplatzer device.…”

Kissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices

“…But multiple device use might be considered in the case of multiple large defects with increased inter-defect distances. In this situation total septal length and sufficient rim existence for each defect are important [2][3][4][5]. We revealed two defects echocardiographically but flow patterns led us to suspect additional defects.…”

“…Device erosion or embolisation was observed in no cases. One patient was lost at the 30 th day but all 3 devices were found to be intact; 200 ml of serous pericardial fluid was found but no finding for myocardial inflammation or erosion was observed [4]. Both studies emphasised that percutaneous closure of multiple ASDs was safe and effective based on the case selection [1,4].…”

“…Existence of multiple defects and aneurysmatic septum are factors that might also make the intervention more difficult. Number and size of the defects, inter-defect distances and elasticity of the rims are also important parameters in multiple defects [2][3][4]. Swiss cheese like ASDs may be closed with an "Amplatzer cribriform septal occluder device".…”

“…Colour Doppler showed the partially closed third defect and the residual flow. Previous studies found that residual flow existed after the closure of multiple defects without any hemodynamic strain and they observed that they disappeared in the follow-up [2][3][4][5].…”