PERCUTANEOUS CLOSURE OF SECUNDUM-TYPE ATRIAL SEPTAL DEFECTS USING AMPLATZER SEPTAL OCCLUDERS
Abstract
Background. Percutaneous closure of secundumtype atrial septal defect (ASD II.) is becoming an increasingly widespread alternative to surgical closure. We report our initial clinical experience with the percutaneous closure of ASD II. using Amplatzer Septal Occluders (ASO) in Slovenia.
Patients and methods. Fifty consecutive patients with ASD II. were evaluated for transcatheter closure with ASO using both transthoracic (TTE) and transesophageal echocardiography (TEE). Transcatheter closure was performed under general endotracheal anesthesia with simultaneous fluoroscopy and TEE guidance. The stretch defect diameter was measured using an Amplatzer sizing balloon catheter. The ASO having a 2–4 mm larger diameter than the stretched defect diameter was selected for defect closure. Follow-up was scheduled 10 min, 24 hours, 1 month, 3 months, 6 months, 1 year and then annually after the procedure.
Results. Eight patients (16%) with deficiency of the posterior, inferior anterior, or inferior posterior rim were not deemed suitable for transcatheter closure and were referred for surgery. Fourteen patients (28%) had centrally positioned defects, 23 patients (46%) defects with a deficient superior anterior rim, 3 patients had multiple defects, while 2 patients presented with atrial septal aneurysm: 1 associated with a single perforation and 1 with multiple perforations. So far, cardiac catheterization has been performed in 24 patients, while the remaining 12 patients are waiting cardiac catheterization. During cardiac catheterization, 1 additional patient was excluded from percutaneous closure due to an additional defect unsuitable for percutaneous closure. Therefore, percutaneous closure was attempted in 23 patients. In a single patient we retrieved an inadequately positioned occluder and referred the patient for elective surgical closure. A large Eustachian valve caused this single failure of occluder positioning in our series. In the remaining 22 patients successful implantation of ASO was achieved. The correct position of the occluder was achieved in 13 patients at the first attempt, while in 9 patients several attempts were necessary. The complete closure rate rose from 70% at the end of the procedure to 95% at the latest follow-up. Regression of right ventricular M-mode echocardiographic dimension was evident from 26.4 ± 3.1 mm before closure to 21.7 ± 4.2 mm at 1 month (p < 0.05), and to 19.1 ± 3.2 mm (p < 0.05) at 3 months follow-up. Late complications were not detected during a 12-month follow-up.
Conclusions. Percutaneous closure of ASD II. using ASO is a safe and effective alternative to surgical closure. Up to 80% of ASD II. are amenable to percutaneous closure using ASO. Careful patient selection, precise stretch defect diameter measurement, selection of proper occluder size and precise positioning of the occluder are crucial for successful defect closure. Additional clinical experience in a larger number of patients and long-term follow-up results are required to further support our statements.
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References
Šamánek M. Children with congenital heart disease: probability of natural survival. Pediatr Cardiol 1992; 13: 152–8.
Cheitlin DM, Rapaport E. Interatrial septal defect in the adult. In: Chatterjee K, Cheitlin DM, Karliner J, Parmley WW, Rapaport E, Scheinman M. Cardiology: an illustrated text/reference. Philadelphia: J. B. Lippincott company, 1991: 1143–51.
Murphy JG, Gersh BJ, McGoon MD et al. Long-term outcome after surgical repair of isolated atrial septal defect. N Eng J Med 1990; 323: 1645–50.
Bradenburg RO Jr., Holmes DR Jr., Bradenburg RO et al. Clinical follow-up of paroxysmal supraventricular tachyarrhytmias after operative repair of a secundum type atrial septal defect in adults. Am J Cardiol 1983; 51: 273–3.
Ward C. Secundum atrial septal defect: routine surgical treatment is not of proven benefit. Br Heart J 1994; 71: 219–23.
King TD, Mills NL. Nonoperative closure of atrial septal defects. Surgery 1974; 75: 383–8.
Sideris EB, Sideris SE, Thanapoulos BD et al. Transvenous atrial septal defect occlusion by the buttoned device. Am J Cardiol 1990; 66: 1524–6.
Justo RN, Nykanen DG, Boutlin C et al. Clinical impact of transcatheter closure of secundum atrial septal defects with the double umbrella device. Am J Cardiol 1996; 77: 889–92.
Latson L, Benson L, Hellenbrand W et al. Transcatheter closure of ASD – Early results of multicenter trial of the bard clemsheel septal occluder. Circulation 1991; 84: Suppl II: 544–4.
Rao PS, Sideris EB, Hausdorf G et al. International experience with secundum atrial septal defect occlusion by buttoned device. Am Heart J 1994; 128: 1022–35.
Das GS, Shrivastava S, O’Laughlin MP et al. Intermediate term follow up of patients after percutaneous closure of atrial septal defects with the Das Angelwings devices. Circulation 1996: 94: Suppl 1: I-56–I-66.
Lloyd TR, Rao PS, Beekman III RH, Mendelsohn AM, Sideris EB. Atrial septal defect occlusion with buttoned device (a multi-institutional U. S. trial). Am J Cardiol 1994; 73: 289–91.
Agarwal SK, Ghosh PK, Mittal PK. Failure of devices used for closure of atrial septal defects: Mechanisms and management. J Thorac Cardiovasc Surg 1996; 112: 21–6.
Masura J, Gavora P, Formanek A et al. Transcatheter closure of secundum atrial septal defects using new self-centering Amplatzer Septal Occluder: Initial human experience. Cathet Cardiovasc Diag 1997; 42: 388–93.
Thanopoulos BD, Laskari CV, Tsaousis GS, Zarayelyan A, Vekiou A, Papadopoulos GS. Closure of atrial septal defects with the Amplatzer occlusion device: preliminary results. J Am Coll Cardiol 1998; 31: 1110–6.
Chan KC, Godman MJ, Walsh K, Wilson N, Redington A, Gibbs JL. Transcatheter closure of atrial septal defect and interatrial communications with a new self-expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience. Heart 1999; 82: 300–6.
Momenah TS, McElhimney DB, Brook MM, Moore P, Silverman NH. Transesophageal echocardiographic predictors for successful transcatheter closure of the defect within the oval fossa using CardioSEAL septal occlusion device. Cardiol Young 2000; 10: 510–8.
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