Abstract
BackgroundThere are no unanimous reports on different layouts and classifications of multi-hole secundum atrial septal defects (MHASD) and subsequent standardized occlusion techniques. The MHASD can be isolated or cribriform with variable inter-defects distance. In this retrospective study, experience-based classification and two approaches-based occlusion results are presented.MethodsWe retrospectively collected and analyzed data of 150 MHASD patients from 1320 patients who underwent atrial septal defect occlusion in our institute. The MHASD patients were categorized into 4 types; type A, B, C and D and occluded under exclusive transesophageal echocardiographic guidance. According to different types, 122 patients were occluded using peratrial approach and 28 patients via percutaneous approach. In type A, single device implantation is performed to occlude the large hole and squeeze the small one. For type B single or double-device deployment was performed depending on an inter-defects distance. In type C and D, a patent foramen-ovale (PF) device was selectively positioned to the central defect to occlude the central defect and cover the peripheral ones. In peratrial approach, 8 patients underwent inter-defects septal puncture technique to achieve single-device occlusion. The intracardiac manipulation time, procedural time, double device deployment, redeployment rate, residual shunt, and proportions were analyzed between (and within peratrial technique) two techniques.ResultsSuccessful occlusion was achieved in all 150 patients. Single device occlusion was applied in 78/84 type A and 22/37 type B patients (p < 0.05). Double device occlusion was more applicable to type B than A patients (p < 0.01). Sixteen of 21 type C and all type D patients used PF device for a satisfactory occlusion. Redeployment of the device occurred frequently in type B patients than A (p < 0.01). The intracardiac manipulation time and procedural time were shorter in type A than B (p < 0.05). The intracardiac manipulation time was also shortened in type A peratrial than type A percutaneous group (p < 0.05). Complete occlusion rate for all patients at discharge was 70% and rose to 82% at 1 year follow up.ConclusionsThe diverse layouts and classification of MHASDs can help to choose different techniques and proper devices of different kinds to achieve better occlusion results.
Highlights
Percutaneous device closure of secundum atrial septal defect (ASD) has been increasingly developed and applied clinically with optimal results
In recent years peratrial device closure of ASD has been reported effective [5, 6] which can be considered an alternative to surgical and percutaneous approaches especially in large ASD and complex multi-hole secundum atrial septal defects (MHASD). It has the advantages of perpendicular short entry route to the interatrial septum, the high selectivity of defect-crossing, and accurate device positioning. The purpose of this retrospective study is to introduce the classification of MHASDs and to evaluate the efficacy of different methods in closing different types of MHASDs under single transesophageal echocardiographic (TEE) guidance
Statistical comparisons of proportions were analyzed using a chi-square or Fisher’s exact test
Summary
Percutaneous device closure of secundum atrial septal defect (ASD) has been increasingly developed and applied clinically with optimal results. It has the advantages of perpendicular short entry route to the interatrial septum, the high selectivity of defect-crossing, and accurate device positioning The purpose of this retrospective study is to introduce the classification of MHASDs and to evaluate the efficacy of different methods in closing different types of MHASDs under single transesophageal echocardiographic (TEE) guidance. There are no unanimous reports on different layouts and classifications of multi-hole secundum atrial septal defects (MHASD) and subsequent standardized occlusion techniques. The MHASD can be isolated or cribriform with variable inter-defects distance In this retrospective study, experience-based classification and two approachesbased occlusion results are presented
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