Closure Of Secundum Atrial Septal Defect Research Articles

279: The transcatheter closure of Atrial Septal Defect (ASD) in patients older than 60 years : Retrospective study of 41 cases

Transcatheter closure of ASD is now proposed as first line treatment for the elderly patients. The aim of our study is to evaluating the transcatheter closure of ASD in patients older than 60 years. The records of 41 patients (37 women, 4 men) who are over 60 years (69.88±6 years, range 61-82 years), referred between April 1998 and December 2010 for transcatheter closure of secundum ASD, were retrospectively reviewed ASD was discovered during the assessment of patients with dyspnea (17) or arrhythmia (17). Average age at time of diagnosis was 62.4±14.89 years (range 14-82 years). 37.8% of cases had a delayed diagnosis. At time of the procedure, 19 patients (46.3%) had supraventricular arrhythmia and 82.9% of patients were dyspneic. Shunt ratio was 2.50±0.66, defect size 19.67±6.76 mm, stretched diameter 24.36 mm±5.87, device diameter of 24.49 mm±6.58. One patient was recused, because of increased left atrial pressure at occlusion test. Fluoroscopy time was 7.01±4.41 min. Success rate is 97.5%. Complete closure rate at one day and one month was 84.6% and 94.9% respectively. Systolic pulmonary pressure decreased from 49.37 to 34,58 mmHg at one month. Hospital stay was 3.58 days ± 2.71. Periprocedural complication rate was 12.2%. 2 complications were major: one death by esophageal hematoma, and one oropharyngeal bleeding, and 3 minors: 3 femoral arteriovenous fistulas. At late follow-up (34±44 months, range 1month to 12 years), 34 patients were in stage one, 4 recurred supraventricular arrhythmia, 1 needed pace maker for sinus node dysfunction. Transcatheter closure of ASD in ederly patients is effective. It does not change rhythmic status but allows symptomatic improvement.

Feasibility and Safety of Transthoracic Echocardiography-Guided Transcatheter Closure of Atrial Septal Defects with Deficient Superior-Anterior Rims

Although previous studies showed that transthoracic echocardiography (TTE) can be used to guide transcatheter closure of atrial septal defect (ASD), whether TTE can be used to guide transcatheter closure of secundum ASD with a deficient superior-anterior rim is unknown and this critical issue was addressed in the present study. A total of 280 patients with secundum ASD who underwent transcatheter ASD closure were recruited and divided into groups A and B depending on ASD superior-anterior rim>4 mm (n = 118) or ≤4 mm (n = 162). TTE was used to guide Amplatzer-type septal occluder (ASO) positioning and assess residual shunt. Procedure success was defined as no, trivial and small residual shunt immediately after the procedure as assessed by color Doppler flow imaging. Group A and group B did not differ in complication rate (8.55% vs.7.55%), procedure success rate (98.3% vs. 95.0%) or complete closure rate immediately after the procedure (89.7% vs. 89.3%) or at 6-month follow-up (98.3% vs. 96.8%). The mean procedure and fluoroscopy time in group B were much longer than those in group A. In conclusion, the absence of a sufficient superior-anterior rim in patients undergoing percutaneous closure of secundum-type ASDs using fluoroscopic and TTE guidance is associated with slightly greater device malposition and migration as well as increased procedural and fluoroscopic times, but the overall complication rate did not differ with TTE guidance when compared to historical controls that used TEE guidance.

Abstract 18696: Feasibility of Transcatheter Closure of Secundum Atrial Septal Defect with Deficient Rims Other than the Antero Superior

Introduction. Transcatheter closure of secundum atrial septal defect (ASD) with deficient rims is usually contraindicated except in cases with a deficient antero-superior rim in whom percutaneous closure is well demonstrated. Our goal was to assess the feasibility of transcatheter closure for secundum ASD with deficient rims (<5 mm) other than the antero-superior. Method. Between January 1st, 2008 and december 31, 2011, 192 patients underwent percutaneous closure of ASD in our institution under transesophageal echocardiography guidance in children and intracardiac echocardiography guidance in adults. Amplatzer devices (Amplatzer Septal Occluder or Cribriform) were used in 191 whereas one case without deficient rim was closed with intrasept ASD occluder. We retrospectively analyzed the outcomes of the 43 patients (22.4%, 26 children) with one or more deficient rim. Results.The median age and weight was 16(1.1 to 85) years and 56(8.8 to 99)Kg, respectively. Deficiency of the inferior (toward the AV valves, n= 11), inferior- posterior (toward the inferior vena cava, n=15), and the superior -posterior rim (toward the superior vena cava, n= 17) was confirmed by transesophageal echocardiography in all the cases. Transcatheter closure was successfully accomplished in 37 (86%) of the cases with a median device size of 28(10 to 40) mm. A modified method of implantation (sizing balloon technique) was used in 30 patients (70%).In 6 patients (5 children) the ASD could not be closed. Four children experienced device embolization few hours after successful transcatheter closure and underwent surgical ASD closure without further complication. By Fisher’s exact test, deficiency of the inferior-posterior rim was associated with failure or embolization(p = 0.05)and there was a trend for adult age to be associated with a low risk of embolization or failure (p= 0,06). Conclusion. Transcatheter closure of secundum ASD is feasible in patients with deficient rims. However, this cannot be recommended because of an intolerable rate of embolization. Possibly, transcatheter closure of such secundum ASDs with deficient rims may be more successful in the adult population.

Percutaneous device closure for secundum-type atrial septal defect: short and intermediate-term results.

Device closure of an isolated secundum type atrial septal defect (ASD) has been used as an alternative method for open surgical closure with comparable success and lower morbidity. In this study we evaluated the procedural success and mid-term follow-up results of percutaneous closure of secundum ASD with an Amplatzer™Septal Occluder(ASO) device or a Figula ASD occluder device. From June 2001 to January 2009, 74 consecutive patients were scheduled for percutaneous device closure in two centers in Tehran, Iran. All patients had a stretched defect diameter of 30mm or less. After using a sizing balloon to measure the stop-flow diameter, device implantation was performed under the guidance of a trans-esophageal echocardiography (TEE).The size was generally 1 - 2 mm larger than the stretched diameter. Patients were followed for an average of 11 ±4 months. The median stretched diameter of the defect was 20.7±4.8 mm (range: 8 - 30 mm).A total of 73 devices were used in this study. Device closure was successful in 72 (97.2%) out of 74 patients. Repositioning of the device was required in one patient. Major complications(including significant residual shunt and device embolization) occurred in 3 (4%) patients.There was no procedure-related mortality in our patients. Mild-to-moderate residual shunt was detectable in 10 (13.7%) patients immediately following the procedure and in 5 (6.7%) patients 24 hours after the procedure. None had residual flow across the device at the end of the follow-up period. Device closure of ASD has a safety profile comparable to open surgical repair and can effectively close the defect with excellent procedural and mid-term results.

Device Closure of Secundum Atrial Septal Defects in Children

This study sought to determine institutional complication rates in a previously underreported patient population and discuss referral indications. There has been a trend over the years for referral of younger and smaller patients for "elective" closure of atrial septal defects (ASD). In general, the risks associated with ASD device closure are believed and reported to be relatively low. Complication rates in this group of smaller patients are not well described in the literature for either percutaneous or surgical approaches. Retrospective review of all patients who underwent elective transcatheter closure of secundum ASD between March 2000 and April 2010. We excluded all children >15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated. We identified 128 patients meeting criteria with a median procedural age of 1.92 years (3 months to 4.92 years), and median weight of 10.8 kg (4.3 to 14.9 kb). There were 7 major (5.5%) and 12 minor (9.4%) complications. Nearly two-thirds of referrals were for right heart enlargement or poor growth. Rate of resolution of residual shunt was 99%. When compared with age, there was no difference in the rate of resolution of right heart enlargement. No clinically significant improvement in growth was observed. Transcatheter ASD closure in small children is highly successful, but with an increase in previously perceived complication rates. In small, asymptomatic patients, deferral of closure until the historically established timeline of around 4 to 5 years of age should be strongly considered.

Safety and Long‐Term Outcome of Modified Intracardiac Echocardiography‐Assisted “No‐Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect

The need for sizing the secundum atrial septal defect (ASD) with the balloon sizing technique is still debated at least in adult patients. We sought to prospectively evaluate the effectiveness of intracardiac echocardiography (ICE)-aided sizing technique for transcatheter closure of secundum ASD, without using a balloon sizing. In a prospective 5-year registry, we enrolled 81 patients (mean age 48 ± 13.7 years, 54 females) who had been referred to three different centers for atheter-based closure of secundum ASD. Eligible patients underwent ICE study and closure attempt. In a preliminary group of 21 patients, sizing balloon was performed under ICE guidance to assess the value of rim thickness necessary for device anchorage. In the remaining 60 patients, the retrieved value of the rim thickness was measured on ICE and used as key points to measure the defect and select the device. In the preliminary group of patients, the value of thickness at point of initial deflection by the balloon was 1.23 ± 0.1 mm. ASD diameter in the study group was measured at the point of rim with at least 1.2 mm and the mean ASD diameter was 26.2 ± 10.1 mm. Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 93.3%, and 0%, respectively. On mean follow-up of 5.4 ± 1.8 years, the occlusion rate was 98.7% with no long-term complications. Our novel ICE-sizing technique appears to be safe and effective in adult patients, thus eventually minimizing overestimation, costs, and potential complications of balloon sizing.

De Novo Thrombus on an Atrial Septal Defect Device 3 Years After Its Implantation

The secundum atrial septal defect (ASD) is noted to occur in 1 per 1,500 live births and is the fourth most common congenital heart defect (CHD) [Anzai et al. in Am J Cardiol 93:426-431, 2004]. Early complications with percutaneous closure of secundum ASDs include device malposition and embolization, arrhythmias (primarily atrial fibrillation), pericardial effusion, residual shunt, and thrombus development on the left atrial disk [Chessa et al. in J Am Coll Cardiol 39:1061-1065, 2002, Co-Burn and William in Moss and Adams' Heart disease in infants, children and adolescents including fetus and young adults. Williams and Wilkins, Baltimore, 1995]. We present a patient with a very late complication of device thrombus after percutaneous secundum ASD device closure.

Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

Objectives: This study was aimed to evaluate our clinical experiences and investigate results of percutaneous clo-sure of secundum atrial septal defects (ASD) in our clinic. Results: We retrospectively included 70 patients (19 male, 51 female) undergoing percutaneous ASD closure proce-dure with mean age of 36p14.8 (17-75) in our clinic between March 2008 and January 2010. Defect diameter meas-ured by transesophageal echocardiography was 19.7p6.3 mm (6-32 mm). Device size used for percutaneous closure of ASD was 23.7p6.2 (12-36). Devices used for percutaneous closure were nitinol-based devices including Amplatzer (64.7%), Cardiofix (26.7%) and biodegredable BioStar (8.6%). The percutaneous closure procedure was successful at 68 of 70 (97%) patients. In 2 patients procedure failed. Failure reason was device embolization in one patient and device strut fracture in other; so these 2 patients referred to surgery. During follow up 2 more patients also referred to surgery because of device embolization in first day control. In 3 patients (4.2%) supraventricular arrythmias that are converted to sinus by cardioversion are observed. Mean follow up interval was 18.6p9.6 months (1-44) and during this period peripheral vascular complications, cerebrovascular accidents, thrombus on devices, device erosion or death is not observed. Conclusion: Percutaneous closure of secundum ASD which started to replace surgical treatment of ASD in last dec-ades is safe and effective method in short to mid-term period. However because of potentially serious complication risks it should be performed in special centers by operators who are experienced in treating structural heart diseases.

Analysis of maximum P-wave duration and dispersion after percutaneous closure of atrial septal defects: Comparison of two septal occluders

Amplatzer septal occluder (ASO) is the most widely used device for closure of atrial septal defect (ASD). Figulla septal occluder (FSO) is a similar device to ASO with some structural innovations. The aim of study is to assess the maximum P-wave duration (Pmax) and dispersion (Pd) in patients who underwent ASD closure with both devices, to determine the effects of structural innovations on atrial electrical inhomogeneity. The study is a retrospective cohort analysis. Between December 2005 and March 2010, 121 patients underwent percutaneous closure of secundum ASD were included in this study. FSO was used in 79 patients, ASO in 42 patients. Pmax and Pd were measured on the surface electrocardiography before and soon after procedure. For comparison of P-wave parameters initially and after procedure paired t-test was used. Correlation analysis was performed using Pearson correlation test. Pmax and Pd were significantly increased immediate after procedure (p<0.001). In FSO and ASO group pre/postprocedural Pd were 38.3 ± 2.7/ 44.1 ± 2.7 msec and 37.5 ± 2.5/ 50.1 ± 2.2 msec respectively. ASO group had a greater postprocedural Pmax and Pd (p<0.001). Left and right atrial disc diameter and device size were the strongest correlates of Pd (r=0.52, p<0.001; r=0.58, p<0.001; r=0.35, p=0.001, respectively). Moderate correlation was found between pre-intervention Pd and age (p=0.008). Pmax and Pd were significantly increased soon after atrial septal defect closure procedure in both devices. Pd is significantly lower in patients closed with FSO device. Difference may be due to the distinctive texture of devices. There was no significant difference in terms of clinically apparent arrhythmia after closure with both device types.

Intermediate-Term Effects of Transcatheter Secundum Atrial Septal Defect Closure on Cardiac Remodeling in Children and Adults

Intermediate-Term Effects of Transcatheter Secundum Atrial Septal Defect Closure on Cardiac Remodeling in Children and Adults

Device Closure of Atrial Septal Defect

Transcatheter closure of atrial septal defects (ASDs) has become an alternative to open surgical procedures. The Amplatzer septal occluder (ASO) has been approved since 2005 in Japan, but there are still many concerns about adverse events, and information about outcomes and complications is limited. The objective of this study was to assess the immediate and mid-term outcomes of device closure of secundum ASDs. From August 2005 to July 2011, 208 consecutive patients with a significant secundum ASD underwent percutaneous closure with the ASO [72 males, 136 females; median age, 7.3 years (range, 3.3-21.9 years)]. Follow-up was available for 206 (99%) patients. Device closure was successful in 203 (98%) patients. Device embolization occurred in 1 case within 1h of device implantation, but the device was surgically retrieved without any neurological sequelae. During the follow-up period, complete closure was observed in 202 of 203 patients. There were no cases of erosions, late embolization, thrombus formation, or death. Transcatheter closure of ASDs using the ASO is safe and effective, with excellent results during mid-term follow-up. Appropriate patient selection and accurate device selection is mandatory to avoid serious complications.

Five-year Follow-up of Intracardiac Echocardiography-assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect

We sought to prospectively evaluate long-term follow-up results of intracardiac echocardiography-aided transcatheter closure of complex atrial septal defects (ASD) in the adults. Prospective multicenter registry in tertiary care hospitals. Over a 5-year period, we prospectively enrolled 56 patients (mean age 49 ± 16.7 years, 24 females) who have been referred to our center for catheter-based closure of complex secundum ASD (> 25 mm diameter, deficiency of ≥ 1 rim, multiple secundum ASD, multiperforated ASD, associated incomplete floor of the fossa ovalis with or without aneurysm, embryonic remnants of incomplete atrial septation). All patients were screened by means of transesophageal echocardiography before the operation. Eligible patients underwent intracardiac echocardiography study and closure attempt. Forty patients underwent a transcatheter closure attempt: transesophageal echocardiography-planned device type and size were modified in 32 patients (64%). Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 90%, and 2%, respectively. On mean follow-up of 5.4 ± 1.8 years, the follow-up occlusion rate was 98%. During follow-up, only one case of permanent atrial fibrillation was observed. There were no cases of aortic/atrial erosion, device thrombosis, or new atrioventricular valve dysfunction. Intracardiac echocardiography-guided complex secundum ASD transcatheter closure is safe and effective and appears to have excellent long-term results, thus minimizing potential complications resulting from the complex anatomy.

Feasibility of transcatheter closure in unselected patients with secundum atrial septal defect, using amplatzer devices and a modified sizing balloon technique

We aimed to assess (1) the role of surgical versus transcatheter closure techniques and (2) the impact of a modified implantation technique to optimize closure of secundum septal defects with the Amplatzer device. Despite several comparative studies, the respective roles of surgical and transcatheter closure are not clarified. Additionally, the impact of modified method of implantation on device closure remains unknown. Fifty-seven unselected patients were referred for secundum atrial septal defect closure in 2009, at a median age and weight of 27.5 (0.8-88) years and 40.6 (5.6-97) kg, respectively. Transcatheter closure was attempted in 53 cases under transesophagal echocardiography guidance in children (n = 28) and intracardiac echocardiography guidance in adults. If standard closure failed, a sizing balloon catheter inflated in the left atrium was used as a support to secure the position of the device upon deployment. Fifty of the 57 cases (88%) were successfully closed with a median Amplatzer Septal Occluder size of 20 (10-40) mm, using the sizing balloon technique in eight (16%) cases. No major complication occurred. A trivial residual shunt remained in two patients (4%) whereas a mild mitral regurgitation appeared in one. By univariate analysis, a deficient superior-posterior rim and a large defect (>15 mm(2) /m(2) ) were associated with the use of the sizing balloon technique (P = 0.04 and 0.03, respectively). A deficient superior-posterior rim and pulmonary hypertension were associated with failure to close the defect (P = 0.02 and 0.03, respectively). The majority of secundum atrial septal defect is amenable to transcatheter closure, using a modified implantation technique in 16% of cases.

Percutaneous closure of interatrial septal defects: mid-term follow-up results

We evaluated short- and mid-term results of percutaneous closure of atrial septal defects (ASD) and patent foramen ovale (PFO) using various closure devices. The study included 278 patients (128 men, 150 women; mean age 39±12 years; range 17 to 66 years) who underwent percutaneous closure of secundum ASD (n=134) or PFO (n=144). All the patients were assessed by transthoracic (TTE) and transesophageal (TEE) echocardiography before the procedure. Percutaneous closure was performed with the Amplatzer (n=180), Occlutech Figulla (n=92) or BioSTAR (n=6) devices. Closure of ASDs was performed under general anesthesia with TEE guidance, and closure of PFOs was performed under local anesthesia with TTE guidance. Follow-up controls were at 1, 6, and 12 months, and annually thereafter. The mean follow-up period was 35.1 ± 24.6 months for ASD cases, and 24.9 ± 15.5 months for PFO cases. The mean device size was 20.2 ± 5.6 mm for ASD cases and 24 ± 2.9 mm for PFO cases. The mean procedural and fluoroscopy times were 28.4 ± 6.1 min and 4.9 ± 2.1 min for ASD closure, and 18.2 ± 5.3 min and 3.6 ± 1.2 min for PFO closure, respectively. Procedural device embolization occurred in only one patient. No recurrent embolic events occurred after PFO closure, and no residual shunts were seen after ASD closure. Device thrombosis developed in two patients during the procedure and in one patient at one-year follow-up. Percutaneous closure of secundum ASDs and PFOs using the Amplatzer, Occlutech Figulla, and BioSTAR devices is an effective and safe treatment option.

Transcatheter closure of secundum atrial septal defects using the amplatzer septal occluder: initial experience in taiwan

We assessed the safety and efficacy of closure of secundum-type atrial septal defects (ASDs) using the Amplatzer septal occluder (ASO) in a sample of Taiwanese patients. Between June 2000 and April 2002, 25 patients underwent transcatheter closure of their secundum-type atrial septal defect/s using the ASO device. The procedures were performed under general anesthesia with access through the femoral vein using guidance provided by transoesophageal echocardiography (TEE) and fluoroscopy. Twenty-two patients had larger defects with right cardiac dilatation and paradoxical interventricular septal motion, while family concerns were the primary indications for closure for the other three. Twenty-five ASO devices were successfully implanted in 24 patients, with a lone individual referred for surgery due to implantation failure. The mean age of the patients was 12.5 years. The male-female ratio was 12:13. The mean pulmonary-systemic blood flow ratio (Qp:Qs) was 2.5:1. The ASD size (mean 20.2 mm; range 8–28.5) was measured using transoesophageal echocardiography, with a balloon-stretched diameter of 8–29.5 mm (mean 20.5). The size of the implanted devices ranged from 9–36 mm (mean 23.1). Fluoroscopy duration ranged from 9.7–41.2 minutes (mean 23.5). A residual shunt, assessed not significant from transoesophageal echocardiography, was detected in one patient who had received two ASO devices for multiple ASDs. Follow-up intervals ranged from 0.1–2 years (median 1.0), with no late complications determined for any patient. Transcatheter closure of secundum ASDs using the Amplatzer septal occluder is a safe and effective alternative to the surgical analog. With careful selection of patients, secundum ASDs can be successfully closed, with minimal procedural morbidity and excellent early results. Long-term follow up is necessary for evaluation, however, if this procedure is to be as effective as surgery.

302 Trancatheter closure of the majority of ostium secundum atrial septal defects is feasible with the adjunction of the sizing balloon-assisted technique in difficult cases

In our centre, device closure is the first-intention therapy for secundum atrial septal defect (ASD). In difficult cases we use a Meditech sizing balloon to optimize position of the device. We sought to determine (1) the efficacy of this sizing balloon-assisted technique (SBT) and (2) the percentage of ASDs that can be percutaneously closed. In 2009, 65 patients (37 female) were referred for secundum ASD closure, at a median age and weight of 27.5(0.8 to 88) years and 40.6(5.6 to 97) kg, respectively. Six had pulmonary hypertension. Eight patients had surgical closure because of referral cardiologist and/or patient's choice. Among the 57 remaining patients, 4 were unsuitable by echocardiography and surgically closed. Transcatheter closure was attempted in 53 cases, including 28 children (53%), and was successful in 50 cases, including 10 with SBT (20%). Amplatzer devices were used in all the patients with a median Amplatzer septal occluder (ASO) size of 20 (10 to 40) mm. A 12 mm ASO could not be positioned in a 5.6 kg infant. Surgical closure was contraindicated for poor general condition (former 26 weeks premature baby with severe bronchodysplasia). Transcatheter closure failed in 2 cases, despite SBT. No major complication occurred. Five patients (10%) had a trivial residual shunt. By univariate analysis, the deficiency of superior rim (<5 mm from the defect) and a large ASD size were associated with the use of SBT (p = 0.04 and 0.002, respectively). The deficiency of superior rim and pulmonary hypertension (mean > 25 mmHg) were associated with failure to percutaneously close the ASD (p = 0.02 and 0.03, respectively). Out of 57 patients candidates for transcatheter closure, 50 were successfully closed percutaneously (87%). Transcatheter closure of ASD is successfully accomplished in the majority of the cases. The SBT is safe and useful for device positioning and delivery in patients with large ASDs and deficient superior rim.

Closure of ostium secundum atrial septum defect with the Atriasept occluder: Early European experience

This multicentre study sought to report the safety and efficacy of the ATRIASEPT septal occluder to repair atrial septal defect (ASD). The ATRIASEPT is a low profile, flexible, double disk occluder with centering system specifically designed for closure of ostium secundum ASD. Patients were enrolled from four participating European sites and followed up for 12 months post procedure. Outcomes were evaluated, including closure success and incidence of adverse events. Seventy-six patients received the ATRIASEPT device. Mean size of the defect was 15 +/- 4 mm. Closure success was observed in 69 patients (89%) at the end of the procedure. Sixty-four patients had a six-month follow up with a complete closure by 58 patients (90%). Minor adverse events occurred in two patients. Significant functional improvement was reported by all symptomatic patients. Percutaneous closure of ASD ostium secundum type defects with the ATRIASEPT is safe and effective with high success rate and excellent mid-term outcome.

Transcatheter closure of secundum atrial septal defects in patients aged over 40: a follow-up of outcome

Objective:To evaluate the safety and effectiveness of transcatheter closure of secundum atrial septal defects(ASD)in patients aged over 40 years old.Methods:A total of 115 patients with secundum ASD,aged 40 or over,who were treated by transcatheter closure in our hospital from Oct.1998 to Jul.2005,were enrolled in this study,including 106 with single ASD,eight with multiple ASD and one with complicated patent foramen ovale.All the 115 patients received ASD closure with the AGA Amplatzer device or ASD occluder made in China.The patients received electrocardiogram(ECG),X-ray and transthoracic echocardiography(TEE)before and three days after operation.Follow-up were done 6 months and 3 years after operation.Results:The transcatheter procedure was successfully done in 114(99.13%)of the 115 patients.The one failed case was transferred to the thoracic surgery department for ASD repair.The complication rate was(3.5%).Classification of heart function(NYHA)improved from 2.11±0.78 to 1.34±0.56 after operation(P0.001).ECG showed that the right bundle branch block(RBBB)disappeared or improved(complete RBBB to incomplete RBBB).X-ray showed a decrease of cordis/thorax ratio(CTR).TTE displayed that the right venticle(RV)volume was significantly decreased(P0.001)and ejection fraction was significantly increased(P0.001).There were three cases of transseptal residual leakage.Conclusion:Transcatheter closure of secundum ASD in patients aged over 40 is safe and effective when indications are strictly followed.

Intermediate-Term Effects of Transcatheter Secundum Atrial Septal Defect Closure on Cardiac Remodeling in Children and Adults

The study aimed to investigate the intermediate-term effects of transcatheter atrial septal defect (ASD) closure on cardiac remodeling in children and adult patients. Between December 2003 and February 2009, 117 patients (48 males, 50 adults) underwent transcatheter ASD closure with the Amplatzer septal occluder (ASO). The mean age of the patients was 15 years, and the mean follow-up period was 25.9 +/- 12.4 months. New York Heart Association (NYHA) class, electrocardiographic parameters, and transthoracic echocardiographic (TTE) examination were evaluated before the ASD closure, then 1 day, 1 month, 6 months, 12 months, and yearly afterward. Transcatheter ASD closure was successfully performed for 112 (96%) of the 117 patients. The mean ASD diameter measured by transesophageal echocardiography (TEE) was 14.0 +/- 4.2 mm, and the mean diameter stretched with a sizing balloon was 16.6 +/- 4.8 mm. The mean size of the implanted device was 18.6 +/- 4.9 mm. The Qp/Qs ratio was 2.2 +/- 0.8. The mean systolic pulmonary artery pressure was 40 +/- 10 mmHg. At the end of the mean follow-up period of 2 years, the indexed right ventricular (RV) end-diastolic diameter had decreased from 36 +/- 5 to 30 +/- 5 mm/m(2) (p = 0.005), and the indexed left ventricular (LV) end-diastolic diameter had increased from 33 +/- 5 to 37 +/- 6 mm/m(2) (p = 0.001), resulting in an RV/LV ratio decreased from 1.1 +/- 0.2 to 0.8 +/- 0.2 (p = 0.001). The New York Heart Association (NYHA) functional capacity of the patients was improved significantly 24 months after ASD closure (1.9 +/- 0.5 to 1.3 +/- 0.5; p = 0.001). At the 2-year follow up electrocardiographic examination, the P maximum had decreased from 128 +/- 15 to 102 +/- 12 ms (p = 0.001), the P dispersion had decreased from 48 +/- 11 to 36 +/- 9 ms (p = 0.001), and the QT dispersion had decreased from 66 +/- 11 to 54 +/- 8 ms (p = 0.001). Five of six patients experienced resolution of their preclosure arrhythmias, whereas the remaining patient continued to have paroxysmal atrial fibrillation. A new arrhythmia (supraventricular tachycardia) developed in one patient and was well controlled medically. Transcatheter ASD closure leads to a significant improvement in clinical status and heart cavity dimensions in adults and children, as shown by intermediate-term follow-up evaluation. Transcatheter ASD closure can reverse electrical and mechanical changes in atrial myocardium, resulting in a subsequent reduction in P maximum and P dispersion times.

Long-Term Follow Up of Secundum Atrial Septal Defect Closure with the Amplatzer Septal Occluder

During the past 15 years, closure of a secundum atrial septal defect (ASD) has moved from a surgical to a percutaneous transcatheter approach. Few long-term studies of the efficacy and safety of closure of an ASD by an Amplatzer septal occluder (ASO) exist. To examine the long-term results of secundum ASD closure using the ASO, data on 94 patients who underwent secundum ASD closure with the ASO between 1998 and 2002 were available and reviewed. Data regarding residual shunt, chest pain, palpitations, arrhythmias, headaches, transient ischemic attacks, cerebrovascular accidents, and mortality were collected. Seven (7.4%) subjects had residual shunts immediately following ASO placement. During follow-up, 4 residual shunts closed for a complete closure rate of 97%. Eighteen (19%) patients reported chest pain during the follow-up period. Twenty-three patients (24%) reported palpitations during the follow up period, 7 were documented arrhythmias, including supraventricular tachycardia, atrial fibrillation, and premature ventricular beats. Migraine headaches were new-onset in 4 patients. Migraine cessation occurred in 2 patients after secundum ASD closure. One child died from a cerebral vascular event 18 months following device placement. Only 1 patient developed mild aortic insufficiency. These data indicate that for up to 120 months of patient follow-up, the ASO continues to be a safe device. Residual shunts and arrhythmias have low incidence post-ASO placement. Given the mortality in one high-risk patient, further investigation into anti-platelet therapy after device placement is warranted.