Transcatheter Closure of Secundum Atrial Septal Defect Using the Amplatzer Device: Single Center Experience in 140 Patients

Abstract

BACKGROUND: Transcatheter closure of secundum atrial septal defect (ASD) is nowadays widely practiced and has replaced surgical ASD closure in many centers. Improvements in design have made the closure devices retrievable, and reduction in the size of the introduction systems allows interventional treatment even in young patients. In this paper we present our experience with the Amplatzer septal occluder device in patients with ASD.

PATIENTS AND METHODS: Between October 2002 and February 2006, 206 consecutive patients with a significant ASD, demonstrated by initial transthoracic echocardiography (TTE), were considered for transcatheter closure with the Amplatzer septal occluder. A total of 156 patients underwent cardiac catheterization, and 140 patients had successful transcatheter ASD closure. Routine examination before catheterization included a standard ECG, a chest x ray, blood tests and TTE. The initial TTE showed the location of the ASD, its septal rim, and its diameter and also helped to measure the length of the interatrial septum in the four-chamber view. These measurements were used to assess the feasibility of transcatheter closure with the Amplatzer device. The “stretched” diameter of the ASD, determined by a balloon sizing catheter, was used to select the diameter of the waist of the device. The size of the selected device was 1 to 2 mm larger than the stretched diameter of the defect. Transesophageal echocardiography was used to monitor the implantation procedure.

RESULTS: The Amplatzer device was finally employed in 140 patients for percutaneous closure of ASD. The age of patients ranged between 5.3 and 70 years, median 21.9 years. Procedure time ranged between 25 and 240 minutes, median 60 minutes; fluoroscopy time ranged between 3.5 and 45 minutes, median 12 minutes. The size of the selected device ranged between 6-40 mm. Two devices were implanted in two patients. Serious procedure related complications (embolization and perforation of the left atrial wall) occurred in two cases. At follow up (10 days to 3.4 years, median 2.3 years) complete closure was documented in 97% of this patient group. Unrecognized during implantation, but detected after release, small additional defect with trivial residual shunt was documented in 4 patients. A young critically ill patient, cyanotic due to right-to-left shunt, with complex congenital heart disease developed a brain abscess three months after implantation.

CONCLUSION: Percutaneous ASD closure with use of the Amplatzer device in this cohort of 140 patients was highly successful with a low complication rate.