Transcatheter Closure of Large Atrial Septal Defects

Abstract

Background-Data are needed on the safety and efficacy of device closure of large atrial septal defects. Methods and Results-Between 1998 and 2013, 336 patients (161 children <15 years) with large, isolated, secundum atrial septal defects (balloon-stretched diameter ≥34 mm in adults or echocardiographic diameter >15 mm/m 2 in children) were managed using the Amplatzer device, at the Marie Lannelongue Hospital. Transthoracic echocardiographic guidance was used starting in 2005 (n=219; 65.2%). Balloon-stretched diameter was >40 mm in 36 adults; mean values were 37.6±3.3 mm in other adults and 26.3±6.3 mm/m 2 in children. Amplatzer closure was successful in 311 (92.6%; 95% confidence interval, 89%-95%) patients. Superior and posterior rim deficiencies were more common in failed than in successful procedures (superior, 24.0% versus 4.8%; P=0.002; and posterior, 32.0% versus 4.2%; P<0.001). Device migration occurred in 4 adults (2 cases each of surgical and transcatheter retrieval); in the 21 remaining failures, the device was unreleased and withdrawn. After a median follow-up of 10.0 years (2.5-17 years), all patients were alive with no history of late complications. Conclusions-Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction. Long-term follow-up showed no deaths or major late complications in our population of 311 patients. (Circ Cardiovasc Interv. 2014;7:837-843.)

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

“…In our study, 2 cases (0.7%) of device migrations were treated via catheterization (n=1) or surgery (n=1) without further complications. Although extreme caution to avoid device migration is essential, we agree with Baruteau et al20) that the morbidity related with ASO migration is rare and easily managed without complication. A recent multicenter cohort study reported that ten devices (1.5%) embolization were treated successfully via catheterization (n=7) or surgery (n=3) without further complications 22).…”

“…Romanelli et al19) reported 97% success rate in 36 large to very large ASD patients, defined as maximal pre-procedural TEE ASD diameter in the range 20–39 mm, while only 17% in 6 extreme large ASD patients (≥40 mm). Recently, Baruteau et al20) reported the largest study of the feasibility and safety of percutaneous closure in both adult and pediatric large ASD patients. Using a definition of large≥34 mm on BSD in 175 adults, they reported 89.7% successful rate.…”

Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

“…When not measured, LA length was estimated as 0.597+0.404·log (Body Surface Area) (18). Very large ASD was defined as an echocardiographic diameter ≥15 mm/m 2 in children (19).…”

“…The procedure was performed as previously described (19,(22)(23)(24) Right-sided cardiac catheterization was performed to evaluate hemodynamics and exclude additional congenital heart defects. Ten (2.6%) patients had pulmonary arterial hypertension (defined as mean pulmonary arterial pressure >25 mmHg).…”

“…With progressive balloon deflation, a slight deformity of the balloon was seen on fluoroscopy, just prior to its popping through the septum, giving the balloonstretched diameter of the ASD (27 Amplatzer Septal Occlusion device was utilized for all the patients. An appropriate sized device was deployed with fluoroscopic guidance, using a standard, previously described placement protocol (19). ASO/LA length ratio was <0.8 in 142 (36.5%) patients, 0.8 to 0.9 in 98 (25.2%), 0.9 to 1 in 67 (17.2%), and >1 in 82 (21.1%).…”