Percutaneous closure of inter-atrial communications (atrial septal defect and patent foramen ovale): single-centre experience and mid-term follow-up

Abstract

Background Percutaneous closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are increasingly being performed. Eff ective closure rate depends on the anatomy of the interatrial septum and the device used, but its relationship with outcome is poorly described. This study aimed at evaluating: (1) eff ective ASD and PFO closure rate, (2) factors related with eff ective closure rate, and (3) factors related with mid-term outcome.Methods All patients who underwent percutaneous ASD or PFO closure at Jessa Hospital Hasselt between April 2002 and February 2014 were enrolled. Closure rate was evaluated using consecutive contrast echocardiography studies. Adverse events were defi ned as a composite of all-cause mortality, hospitalization for heart failure, atrial arrhythmias and thrombo-embolic event.Results One-hundred and two patients (52) 12 y, 42% male, 75 PFO and 27 ASD) were included in the study. Moderate residual shunt was present in 6% and 10% 6 years after ASD and PFO closure, respectively. The presence of an aneurysmatic interatrial septum was associated with residual shunt after PFO closure (HR 0.57 95% CI 0.33-0.96; P= 0.031). Pulmonary hypertension (HR 1.09 95% CI 1.01-1.17; P= 0.017) and a history of atrial arrhythmias in ASD (HR 4.28 95% CI 1.06-17.40; P= 0.046) and age at closure (HR 1.09 95% CI 1.02-1.16; P= 0.012) in PFO patients were related with adverse events. The highest rate of adverse events was observed after placement of a Helex Septal OccluderR. AmplatzerR and OcclutechR devices yielded higher eff ective closure rates.Conclusions Eff ective closure rates were acceptable 6 years after ASD and PFO closure. The presence of an aneurysmatic septum is associated with residual shunting after PFO closure. Pulmonary hypertension in ASD and older age at closure in PFO are associated with adverse outcome. Adverse events are more frequent with the Helex occluder and eff ective closure rate depends on the device used.