Abstract
Introduction: We evaluated chest pain alongside other midterm subjective and objective complications of the transcatheter closure of atrial septal defects (ASDs) and patent foramen ovales (PFOs) with various closure devices. Methods: This cross-sectional study, performed from March 2010 to October 2015 in Rajaie Cardiovascular, Medical, and Research Center, evaluated 313 patients (mean age = 29.12 ± 10 years, 32.9% male) for probable complications associated with the transcatheter occlusion of secundum ASDs (n = 289, mean age = 30.5 ± 11.4 years, 28% male) or PFOs (n = 24, mean age = 42.8 ± 10.2 years). ASD closure was performed under sedation and transesophageal echocardiography (TEE) guidance. Duration of follow-up was 12 ± 3 months (mean follow-up = 11.52 months). Results: Among the subjective complications, chest pain was the most frequent complaint during the follow-up period and although it was common (7.3%), a clear cardiac etiology was rare. Thirteen (4.2%) patients reported palpitation during the follow-up period, and 4 had documented arrhythmias—including atrial flutter, atrial fibrillation, and 2:1 atrioventricular block. Migraine with or without aura occurred in 1.6% of the patients. Objective complications comprising tamponade, device embolization, and thrombus formation occurred in 6 (1.9%) patients. There was no procedure-related mortality in our patients. Conclusion: Transcatheter closure of PFOs and secundum-type ASDs in our adult patients using ASD septal occluders was associated with a high degree of success, minimal procedural subjective and objective complication rates, and excellent short- and midterm results. Although chest pain was common after the first month following ASD closure, there was no cardiac death or aortic erosion in 11.52 months follow up.
Highlights
We evaluated chest pain alongside other midterm subjective and objective complications of the transcatheter closure of atrial septal defects (ASDs) and patent foramen ovales (PFOs) with various closure devices
The present study may be unique insofar as did we investigate the subjective complications of the transcatheter closure of ASDs and PFOs, chest pain, and the age bracket of our patients is relatively older than the age at which such defects are usually diagnosed and treated. (This is due to the specific socioeconomic status of our general population.)
Percutaneous transcatheter closure was performed in the patients with secundum-type ASDs detected by transesophageal echocardiography (TEE) and the presence of significant left-to-right shunting (Qp/Qs >1.5, measured during catheterization), right ventricular (RV) dilatation, dyspnea, reduced exercise tolerance, or paradoxical embolism
Summary
We evaluated chest pain alongside other midterm subjective and objective complications of the transcatheter closure of atrial septal defects (ASDs) and patent foramen ovales (PFOs) with various closure devices. Interatrial septal defects (ASDs) are congenital heart pathologies and are defined as communications between the 2 atria These defects comprise patent foramen ovales (PFOs), true defects in the septum primum and secundum, and defects in the sinus venosus and coronary sinus region.[1] With the introduction of new devices and techniques, transcatheter closure has become the standard procedure for most small- and medium-sized secundum-type ASDs and PFOs in interventional cardiology.[2,3,4] In appropriately selected patients with ASDs and PFOs, the effectiveness and safety of transcatheter closure are deemed comparable to those of surgical interventions.[5,6] ASDs are the most common congenital heart disease in adults; they occur in 1 in every 1500 live births and account for 5% to 10% of all congenital heart diseases.[4,7] Patients with secundum ASDs are not usually symptomatic; most of them will develop symptoms throughout their lives. It is vitally important that the defect be detected early; failure to do so is allied to such serious complications as paradoxical embolism, arrhythmia, pulmonary hypertension, and even right-sided heart failure.[8,9] Transcatheter ASD closure decreases the right ventricular (RV) volume load, RV size, and pulmonary artery pressure and, confers
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