Transcatheter closure of very large (≥ 25 mm) atrial septal defects using the Amplatzer septal occluder

Abstract

Between June 1999 and September 2002, 45 patients (age, 34 +/- 13 years; mean shunt ratio, 2.6 +/- 0.6) underwent transcatheter atrial septal defect (ASD) closure at our institution with the Amplatzer septal occluder (mean device size, 31.4 +/- 3 mm). Patients were selected by transesophageal echocardiography. The mean ASD dimension was 25.3 +/- 3.7 mm and 33 (73%) patients had deficient anterior rim. Specific procedural details included the use of 13 or 14 Fr introducer sheaths and the right upper pulmonary vein approach if the conventional approach failed. There were two procedural failures, with device embolization in both (surgical retrieval in one, catheter retrieval in one). During follow-up (3-30 months; median, 16 months), one patient (59 years) with previous atrial flutter had pulmonary embolism and was managed with anticoagulation. Two patients developed symptomatic atrial flutter. Fluoroscopy time was 31.6 +/- 19.5 min for the first 22 cases and 19.6 +/- 11.4 min for the rest (P = 0.04). Transcatheter closure of large ASDs is technically feasible but careful long-term follow-up is needed to document its safety.

Catheter closure of atrial septal defects with deficient inferior vena cava rim under transesophageal echo guidance

“…The major complication in our series was device embolization in one. Device embolization and other major complications were more commonly found to be associated with deficient IVC rim in other series too, including in our own earlier experience [2,9].…”

“…The scope of catheter closure of atrial septal defects (ASD) has been growing ever since Amplatzer septal occluder (ASO) (AGA Medical Corporation, Minnesota, USA) has been introduced [1][2][3][4][5][6][7][8]. However, those with deficient inferior vena cava (IVC) rim continue to remain a challenging subset [2,9,10].…”

“…However, those with deficient inferior vena cava (IVC) rim continue to remain a challenging subset [2,9,10]. These ASDs are either considered unsuitable for catheter closure or identified as being significantly associated with procedural failures [2,5,[9][10][11]. It is generally believed that the IVC rim cannot be consistently imaged through transesophageal echo (TEE) and intracardiac echocardiography (ICE) is recommended to guide device deployment [10,[12][13][14][15].…”

“…However, those with deficient inferior vena cava (IVC) rim continue to remain a challenging subset [2,9,10]. These ASDs are either considered unsuitable for catheter closure or identified as being significantly associated with procedural failures [2,5,[9][10][11].…”

The relation between atrial septal defect shape, diameter, and area using three-dimensional transoesophageal echocardiography and balloon sizing during percutaneous closure in children

“…3 Underestimation of ASD size increases the risk of device embolization. 2,23,24 Oversized prostheses were easier to implant on the ASD but seemed to increase the risk of complications through mechanical conflict with the surrounding structure. 3 Since 2D echography is not accurate, an invasive balloon calibration is still performed by most centres.…”