Abstract 18696: Feasibility of Transcatheter Closure of Secundum Atrial Septal Defect with Deficient Rims Other than the Antero Superior

Abstract

Introduction. Transcatheter closure of secundum atrial septal defect (ASD) with deficient rims is usually contraindicated except in cases with a deficient antero-superior rim in whom percutaneous closure is well demonstrated. Our goal was to assess the feasibility of transcatheter closure for secundum ASD with deficient rims (<5 mm) other than the antero-superior. Method. Between January 1st, 2008 and december 31, 2011, 192 patients underwent percutaneous closure of ASD in our institution under transesophageal echocardiography guidance in children and intracardiac echocardiography guidance in adults. Amplatzer devices (Amplatzer Septal Occluder or Cribriform) were used in 191 whereas one case without deficient rim was closed with intrasept ASD occluder. We retrospectively analyzed the outcomes of the 43 patients (22.4%, 26 children) with one or more deficient rim. Results.The median age and weight was 16(1.1 to 85) years and 56(8.8 to 99)Kg, respectively. Deficiency of the inferior (toward the AV valves, n= 11), inferior- posterior (toward the inferior vena cava, n=15), and the superior -posterior rim (toward the superior vena cava, n= 17) was confirmed by transesophageal echocardiography in all the cases. Transcatheter closure was successfully accomplished in 37 (86%) of the cases with a median device size of 28(10 to 40) mm. A modified method of implantation (sizing balloon technique) was used in 30 patients (70%).In 6 patients (5 children) the ASD could not be closed. Four children experienced device embolization few hours after successful transcatheter closure and underwent surgical ASD closure without further complication. By Fisher’s exact test, deficiency of the inferior-posterior rim was associated with failure or embolization(p = 0.05)and there was a trend for adult age to be associated with a low risk of embolization or failure (p= 0,06). Conclusion. Transcatheter closure of secundum ASD is feasible in patients with deficient rims. However, this cannot be recommended because of an intolerable rate of embolization. Possibly, transcatheter closure of such secundum ASDs with deficient rims may be more successful in the adult population.