Transcatheter closure of atrial septal defect: principles and available devices

Abstract

There has been a remarkable improvement in the treatment strategy of secundum atrial septal defect (ASD) over the last few decades. Indebted to the improvement in device technology and procedural techniques, transcatheter closure of ASD is currently accepted as the treatment of choice in most patients with secundum ASD. Recent generation devices enable easy and safe deployment of device with the properties of adequate flexibility, re-capturability and repositioning. Use of biocompatible materials with improved device design and refined equipment finish may promote re-endothelialization and reduce potential damage to nearby structures. Most of currently available devices show excellent efficacy and comparable outcome with its own advantages and disadvantages. In addition to improvement of device properties and performance, there has been distinct improvement in procedural technique from numerous experiences of device closure of ASD. Nowadays there are well established principles regarding patient selection, pre-procedural evaluation, step-by-step details of procedure as well as post-procedural follow-up. However, an operator may encounter pitfalls in closing complex lesions such as large defect, rim deficiencies and multiple defects, so every operator has to be familiar with each available device, general principle as well as special issues for complex lesions.

Early to Mid-Term Follow-Up Outcomes of Percutaneous Closure of Atrial Septal Defects Using Recent Generation Devices: a Single-Center Experience

“…No erosion or perforation event was noted 3). Because of these advantages, the GSO device was expected to perform well in smaller defects especially with deficient retro-aortic rims, those in small children, or multi-fenestrated defects, when covering most of the atrial septum is necessary 11). In our study, although there were few patients in GSO group (n=17), the small children under 15 kg were highest (29.4%) in that group, and there was also no significant difference of defect size to BSA ratio among the 3 groups.…”

“…In general, a sufficient septal rim should surround an ASD >5 mm in all directions. Although rim deficiency may potentially increase the risk of complications such as device embolization, erosion and encroachment of device onto nearby cardiac structures, most ASDs with deficient rims were closed successfully and included in this study 11)12). The exclusion criteria were as follows: any associated complex congenital heart disease or other types of ASDs (e.g., sinus venosus and ostium primum defects), bleeding disorders, and any contraindication to antiplatelet therapy, active systemic infection, and intracardiac thrombus.…”

Percutaneous closure of atrial septal defect: a consensus document of the joint group of experts from the Association of Cardiovascular Interventions and the Grown-Up Congenital Heart Disease Section of the Polish Cardiac Society

“…The differences in For a multifenestrated large aneurismatic septum, a non-self -centering device placement may be a good option. 62 Sometimes in such cases, in order to close all the defects while stabilizing the floppy septum, one may consider puncturing the central part of the septum with a transseptic needle and implanting through this hole a non-self -centering implant.…”

Atrial septal defect repair in the age of transcatheter devices

“…One recent case series reported that absence of the aortic rim was common finding among patients who developed erosion [126] . Subsequently, other putative risk factors were also reported as physicians modified their practices and over sizing became less common [127] . Specifically, deficient aortic or SVC rim size, along with balloon sizing were associated with increased risk of erosion [128] .…”