Transcatheter closure of atrial septal defects in children — initial experience with the Das Angel Wings device

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Abstract The most critical issues in non-surgical closure of secundum atrial septal defects are device embolization, residual interatrial shunts, cardiac perforation, and patient selection criteria. This report reviews a three-center experience using the recently developed `Das Angel Wings ASD-occluder'. Between February 1996 and January 1997, 44 children underwent catheterization for closure of secundum atrial septal defects (ASD). The characteristics of the defects were evaluated by transesophageal echocardiography (TEE) and intracardiac balloon catheter sizing. With guidance from TEE and fluoroscopy, the self-centering double umbrella was introduced and deployed by transvenous approach in patients with defects ≤20 mm in diameter. The size of the device used was 1.5 times the size of the defect. Implantation was attempted in 26 patients with a balloon-stretched defect diameter of 11.0–19.5 mm, and it was successful in 23 of them. Eighteen patients were excluded because of one of several limiting criteria: additional cardiac defects in three patients, multiple interatrial fenestrations in four; an unsuitable size of the defect in relationship to atrial chamber dimensions in six; a defect size >20 mm in four; and an inadequate inferior septal rim in one. In three of the 23 patients with implantation, the device was removed surgically after suboptimal placement. After a 3-month follow-up, no device embolization was seen and only one patient had a significant residual interatrial shunt. Surgical removal of the device was necessary in one patient who had a late cardiac perforation with hemopericardium and in another patient with a persistently distorted device. In selected patients, transcatheter closure of secundum atrial septal defects is a feasible alternative to surgical correction. Transesophageal echocardiography is useful in identifying suitable defects with a high probability for successful device closure. The self-centering feature of this ASD-Occluder should diminish the risks of embolization of the device, enhance its transvenous implantation, and result in higher efficacy.