Abstract
Objectives: There is limited data regarding feasibility and safety of very large ASD devices deployment. Percutaneous closure of very large atrial septal defect (ASD) is a valid alternative to surgical approach. But complications like erosion, cardiac perforation, atrioventricular block, pericardial effusion, infective endocarditis, or cardiac arrhythmias may occur following ASD device closure.
 Methods: Forty four patients with very large ostium secundum ASD were studied in a tertiary medical centre. Adult patients with defect size of 38 mm or more and device size of 40 mm or more were selected for device closure. Patients having suitable anatomy, significant left to right shunt(>1.5:1) ,right ventricular volume overload and without significant pulmonary arterial hypertension were chosen for device closure.
 Results : There were thirty six female patients and eight male patients in our study. Majority of our patients (twenty four) were in forty to fifty years age group. Device could be deployed successfully in forty two (95.5%). Twelve patients had device size of 46 mm (27%). Eight patients had 44 mm devices(18%). Forty two millimeter devices were used in sixteen patients (36%). Eight patients had device size of 40 mm(18%).Device embolization occurred in two patients. There were two cases of pericardial effusion and pericardiocentesis was needed in one patients. Transient complete heart block was seen in one patient. Four patients had suffered from transient and self terminating atrial arrhythmias. There was no mortality or erosion in our study.
 Conclusion: Percutaneous closure of very large ASD is feasible and associated with low complication rate
Highlights
Atrial septal defects (ASD) is a common congenital heart disease and it accounts for approximately 10% of all congenital heart defects in children
The first atrial septal defect (ASD) device closure was performed by King and Mills in 1974
There is a paucity of data on transcatheter closure of very large ASDs, especially using the 40-mm devices.Surgical closure is the preferred approach for very large ASDs.This very large defect comprises approximately 20% of patients with ASDs
Summary
Atrial septal defects (ASD) is a common congenital heart disease and it accounts for approximately 10% of all congenital heart defects in children. Transcatheter closure of ostium secundum ASD is a safe and effective procedure. The first ASD device closure was performed by King and Mills in 1974. There is a paucity of data on transcatheter closure of very large ASDs (defect size 38 mm or more), especially using the 40-mm devices.Surgical closure is the preferred approach for very large ASDs.This very large defect comprises approximately 20% of patients with ASDs. There is limited data regarding feasibility and safety of very large ASD devices deployment. Percutaneous closure of very large atrial septal defect (ASD) is a valid alternative to surgical approach. Cardiac perforation, atrioventricular block, pericardial effusion, infective endocarditis, or cardiac arrhythmias may occur following ASD device closure. Methods: Forty four patients with very large ostium secundum ASD were studied in a tertiary medical centre. Conclusion: Percutaneous closure of very large ASD is feasible and associated with low complication rate
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