302 Trancatheter closure of the majority of ostium secundum atrial septal defects is feasible with the adjunction of the sizing balloon-assisted technique in difficult cases

Abstract

In our centre, device closure is the first-intention therapy for secundum atrial septal defect (ASD). In difficult cases we use a Meditech sizing balloon to optimize position of the device. We sought to determine (1) the efficacy of this sizing balloon-assisted technique (SBT) and (2) the percentage of ASDs that can be percutaneously closed. In 2009, 65 patients (37 female) were referred for secundum ASD closure, at a median age and weight of 27.5(0.8 to 88) years and 40.6(5.6 to 97) kg, respectively. Six had pulmonary hypertension. Eight patients had surgical closure because of referral cardiologist and/or patient's choice. Among the 57 remaining patients, 4 were unsuitable by echocardiography and surgically closed. Transcatheter closure was attempted in 53 cases, including 28 children (53%), and was successful in 50 cases, including 10 with SBT (20%). Amplatzer devices were used in all the patients with a median Amplatzer septal occluder (ASO) size of 20 (10 to 40) mm. A 12 mm ASO could not be positioned in a 5.6 kg infant. Surgical closure was contraindicated for poor general condition (former 26 weeks premature baby with severe bronchodysplasia). Transcatheter closure failed in 2 cases, despite SBT. No major complication occurred. Five patients (10%) had a trivial residual shunt. By univariate analysis, the deficiency of superior rim (<5 mm from the defect) and a large ASD size were associated with the use of SBT (p = 0.04 and 0.002, respectively). The deficiency of superior rim and pulmonary hypertension (mean > 25 mmHg) were associated with failure to percutaneously close the ASD (p = 0.02 and 0.03, respectively). Out of 57 patients candidates for transcatheter closure, 50 were successfully closed percutaneously (87%). Transcatheter closure of ASD is successfully accomplished in the majority of the cases. The SBT is safe and useful for device positioning and delivery in patients with large ASDs and deficient superior rim.