Complex Atrial Septal Defects Research Articles

Device-assisted transcatheter closure of large secundum atrial septal defects: a novel approach.

Transcatheter closure of large and complex atrial septal defect can pose challenges and complications during device placement. To improve stability, several assistive techniques have been developed. This retrospective study evaluated the efficacy of the device-assisted device closure technique for large secundum atrial septal defects. Patients who underwent device-assisted device closure of atrial septal defect between December 2023 and August 2024 were analysed. Twenty patients (mean age 38.69 years) underwent device closure of large secundum atrial septal defect with device-assisted device closure technique. The mean atrial septal defect diameter was 31.9 mm. The average thick-to-thick measurement was 38.3 mm, which determined the device size. The majority (18 cases) had thin, floppy margins and two had deficient inferior rim. Successful closure was achieved in 18 patients (90%), while two patients (10%) required other methods of assistance. Based on fluoroscopic guidance, patients were divided into two groups: Group A (8 patients) used anteroposterior projection, and Group B (12 patients) used left anterior oblique-cranial view. After initial two failures with anteroposterior view, all cases were successfully closed using left anterior oblique-cranial projection. Device sizes ranged from 36 to 50 mm (median 40 mm). Cocoon devices were used for sizes up to 42 mm, and Occlunix for larger devices. No significant procedural complications occurred, although two patients had minor post-procedural events. Device-assisted device closure technique offers a promising and safe dynamic assistance approach for transcatheter closure of large and challenging atrial septal defects. The left anterior oblique-cranial view showed promising results, though without statistical significance. While results are encouraging, larger prospective studies are needed to validate its effectiveness.

Perioperative Assessment and Clinical Outcomes of Percutaneous Atrial Septal Defect Closure with Three-Dimensional Transesophageal Echocardiography.

To close the atrial septal defect (ASD) with the transcatheter method, correctly defining the defect and selecting the appropriate closure device size are the most critical steps for the procedure's success. Although ASD can be successfully closed under the guidance of three-dimensional (3D) transesophageal echocardiography (TEE) and two-dimensional (2D) TEE, measurement comparisons between different types of defects are still needed. Our study was designed retrospectively. Sixty-one patients who underwent transcatheter ASD closure with 2D TEE and 3D TEE between 2020 and 2024 were included. The patients were divided into three groups according to the defect shape: circular, oval, and complex; and the measurement results, perioperative process, and clinical outcomes were compared in each group. The average age of the patients was 35.05 ± 13.87 years, and 41 (67.2%) were women. The average follow-up period of the patients was 15.3 ± 9.18 months. No statistical significance was observed in the comparison of measurements obtained with 3D TEE and 2D TEE in the circular and oval defect groups. The differences between the minimum defect diameters of complex defects measured by 2D TEE and 3D TEE (p: 0.037), IVC rims (p < 0.001), aortic rims (p: 0.012), and the differences between implanted device dimensions and the maximum defect diameters measured by both methods were compared; statistical significance was observed (p: 0.025). In circular and non-complex oval defects, it has been observed that the size of the closure device selected with 2D TEE or 3D TEE is optimal, and the procedure is practical and feasible. While the closure of complex ASDs with 3D TEE provides reliable and optimal results, using only 2D TEE in complex ASDs may lead to selecting a smaller-sized device.

Complications and Efficacies of Surgical Versus Transcatheter Closure for Pediatric Ostium Secundum Atrial Septal Defect: A Meta-Analysis.

The optimal approach for pediatric ostium secundum atrial septal defect (ASD) closure remains uncertain. This study aims to assess complications and efficacies of surgical and transcatheter closures. Systematic search in Medline, Cochrane, and EMBASE databases identified cohort studies until July 2023. Complications, length of hospital stay, and efficacy outcomes were evaluated. Subgroup analyses considered ethnicity, ASD size, age, and rim deficiency involvement. Fourteen cohort studies involving 9695 patients were comprehensively analyzed. Regarding complications, the pediatric patients in the surgery group exhibited higher occurrences of cardiac arrhythmia (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.87, p=0.004), pericardial effusion (OR: 14.80, 95% CI: 6.97-31.43, p<0.00001), and pulmonary complications (OR: 2.58, 95% CI: 1.73-3.85, p<0.00001) compared with those in the transcatheter group. However, no significant difference in fever incidence was observed (OR: 2.57, 95% CI: 0.90-7.34, p=0.08). Furthermore, length of hospital stay was notably shorter in the pediatric transcatheter group (mean difference [MD]: 4.00, 95% CI: 1.71-6.29, p=0.0006). Regarding efficacies, both groups demonstrated similar rates of successful closure (OR: 1.97, 95% CI: 0.56-6.92, p=0.29) and residual shunting (OR: 0.55, 95% CI: 0.17-1.77, p=0.31) in the pediatric cohort. Subgroup analyses revealed that surgical residual shunting was notably lower in the European pediatric population (OR: 0.18, 95% CI: 0.07-0.45, p=0.0002), in cases with ASD size exceeding 15 mm (OR: 0.19, 95% CI: 0.08-0.49, p=0.0006), and in pediatric patients younger than 8 years (OR: 0.33, 95% CI: 0.12-0.92, p=0.03). Interestingly, residual shunting involving complex ASD with rim deficiency was more pronounced in the surgery group (OR: 2.66, 95% CI: 1.33-5.32, p=0.006). Both surgical and transcatheter closures are equally effective, with transcatheter closure showing significantly fewer complications. This meta-analysis offers pivotal insights for clinicians grappling with the optimal approach to pediatric ostium secundum ASD closure. The observed higher incidence of cardiac arrhythmias, pericardial effusions, and pulmonary complications in surgical closures underscores the challenges associated with this modality. In contrast, transcatheter closure, with its comparable efficacy and shorter hospital stays, emerges as an appealing and less invasive alternative. These findings equip clinicians with evidence to make informed decisions, optimizing patient outcomes. Subgroup analyses further refine recommendations, emphasizing tailored considerations for European pediatric patients, larger ASDs, and those under 8 years old, ultimately fostering personalized and improved care strategies.

Percutaneous closure of complex atrial septal defects implanting two devices: initial experience with pfm Nit Occlud® ASD-R and PFO devices

Percutaneous closure of complex atrial septal defects implanting two devices: initial experience with pfm Nit Occlud® ASD-R and PFO devices

Update on Transcatheter Device Closure of Congenital Septal Defects.

The goal of this paper is to review currently available devices for closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs). Favorable results from the ASSURED trial resulted in FDA approval for the most recently developed device for transcatheter ASD closure in the United States. Further studies are required to assist in the development or approval of safe devices for transcatheter perimembranous VSD closure in pediatric patients. Device closure is the less invasive and preferred management option for many ASDs, with multiple studies demonstrating lower complication rates, shorter hospital stays, and lower mortality than surgical repair. Complex ASDs that make device closure more difficult include large defects, rim deficiencies, fenestrated defects, multiple defects, and the presence of pulmonary arterial hypertension. Device closure has also become an accepted alternative to surgery for some types of ventricular septal defects VSDs, though challenges and limitations remain. Future innovations including novel devices and techniques are needed to further expand on the types of defects that can be safely closed via transcatheter approach.

FAST technique: fast atrial sheath traction technique for device closure of atrial septal defects.

Transcatheter closure of atrial septal defects (ASDs) is well-established. However, this procedure can be challenging, requiring multiple attempts and advanced implantation maneuvers. From July 2019 to July 2022, patients to whom the fast atrial sheath traction (FAST) technique was applied for ASD device closure were prospectively followed up. The device was rapidly unsheathed in the middle of the left atrium (LA) to let it clamp the ASD from both sides simultaneously. This novel technique was directly applied in patients with absent aortic rims and/or ASD size-to-body weight ratio higher than 0.9 or after failed attempts of standard implantation. Seventeen patients (64.7% males) were involved with a median age of 9.8 years [interquartile range (IQR), 7.6-15.1] and a median weight of 34 kg (IQR, 22-44). The median ASD size on ultrasound was 19 mm (IQR, 16-22). Five (29.4%) patients had absent aortic rims, and three (17.6%) patients had an ASD size-to-body weight ratio higher than 0.9. The median device size was 22 mm (IQR, 17-24). The median difference between device size and ASD two-dimensional static diameter was 3 mm (IQR, 1-3). All interventions were straightforward without any complications using three different occluder devices. One device was removed before release and upsized to the next size. The median fluoroscopy time was 4.1 min (IQR, 3.6-4.6). All patients were discharged the next postoperative day. On a median follow-up of 13 months (IQR, 8-13), no complications were detected. All patients achieved full clinical recovery with complete shunt closure. We present a new implantation technique to efficiently close simple and complex ASDs. The FAST technique can be of benefit in overcoming left disc malalignment to the septum in defects with absent aortic rims and in avoiding complex implantation maneuvers and the risks of injuring the pulmonary veins.

Role of three-dimensional imaging techniques in the management of transcatheter closure of complex atrial septal defects

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Reina Sofia. Instituto de investigación biomédica Maimonides Introduction Percutaneous closure is nowadays considered the treatment of choice of ostium secundum atrial septal defects (ASD) but complex defects may be a challenging. In the last years, the imaging techniques used for ASD assessment have improved considerably, allowing therapeutic approaches in patients with complex morphological features particularly in those with absence of rims. However, there are no studies about the impact of 3D imaging techniques on transcatheter closure of ASD as compared with 2D imaging along time . Purpose To compare the impact of real time 3D Transesophageal echocardiography (3D-RT TEE) and cardiac computed tomography (CCT) on the profile as well as on the success rate of transcatheter closure of complex ASD as compared to 2D imaging. Methods We selected 106 adults patients suffering from ASD of complex anatomy (large≥30 mm, multiple, multifenestrated, aneurysmal, or deficiency of posterior or inferior rims) from 1998 to 2020. Along this time, we compared closure success rate, morphological characteristics, and procedure complications after ASD transcatheter closure. We defined closure success rate as a complete closure without complications. In our study, ASD assessment and further intervention was performed by two-dimensional transesophageal echocardiography (2D-TEE) from 1998 to 2007 (n = 66), whereas 3D-RT TEE and CCT was performed from 2008 to 2020 (n= 40). Results The type of ASD complexity was different between the two diagnostic approaches. Thus, those patients management by 2D-TEE showed more number in large ASD (40,9%), multiple-ASD (34,8%), fenestrated (10,6%), aneurysmal (7,6%) and with lower ring deficiency (6,1%) as compared to those with 3D-RT TEE and CCT (10%, 25%, 15%, 15%, and 35%, respectively, p &amp;lt; 0,05). Although no significant differences were observed, patients from the 2D group needed a second surgical closure more frequently than those treated with 3D-RT TEE and CCT (12,1% vs 5%, p = 0.31). In our study, there were few complications (10 (9,4%), with no significant differences according to the imaging technic used (2D-TEE group: 3 device embolisms, 2 cardiac tamponade, 2 complications of the femoral access; 3D-RT TEE and CCT group: 2 device embolisms and 1 complication of the femoral access. All of them were resolved intraprocedure. Importantly, closure success was higher in those patients manage by 3D-RT TEE and CCT in comparison to 2D-TEE (88% vs. 67%, respectively, p &amp;lt;0.05). Conclusion Transcatheter closure of complex ASD is a secure procedure. However, the use of 3D TEE and cardiac CT improves the success rate of this approach as compared to 2D-TEE and changes the profile of complex ASD treated by transcatheter closure in favor of those with absence of some rims

Transcatheter Closure of Atrial Septal Defect

Background: Over the past decade, percutaneous atrial septal defect (ASD) closure has been the preferred treatment option in many clinical programs for ASD. Percutaneous ASD closures with advanced device architecture and distribution have established user experience and process security. The ability to diagnose has also improved. The devices have evolved from the larger fixtures to the reset zone, being easily eliminated with little residual mesh material and comfortable fitting with the surrounding structures. Biodegradable technology has been introduced and will be considered as a future option. The emergence of the use of the ASD closure device over the last forty years includes improvements that reduce the incidence of adverse effects reported over the years. Issues reported in the literature include thrombus formation, air tightness, device insertion, abrasion, residual shunts and nickel hypersensitivity. Modern tools hold medium and long-term data with excellent results. Multi-sized devices securely close simple and complex ASDs that can re-scan, reset, and detect percutaneous advanced delivery procedures. In this review, the most widely used tools and distribution processes are discussed and the tools that show promise for the future.&#x0D; Conclusion: As the field of transcatheter treatment of atrial septal defects (TC-ASD) and congenital interventional cardiology develops, real-world design studies provide valuable developmental information on aspects of care where there is disagreement about best practices and more research is needed.

Assessment of atrial septal defect using 2D or real-time 3D transesophageal echocardiography and outcomes following transcatheter closure.

BackgroundThe assessment of interatrial septum (IAS) requires a standardized, systematic approach, including two-dimensional transthoracic echocardiography (2D TTE), 2D transesophageal echocardiography (2D TEE), and three-dimensional (3D) TEE. Although 2D TEE has been widely used for the preoperative assessment of atrial septal defect (ASD), its ability to provide reliable information is often limited due to the structural characteristics of IAS. The introduction of 3D TEE provides a unique “en face” view of IAS, which allows the visualization and accurate measurements of diameters, area, and rims of ASD. Hence, appropriate ASD imaging information is particularly important in successful transcatheter closure.MethodsIn this retrospective study, 2D TTE/TEE, and 3D TEE were performed before ASD closure, with 2D minimal and maximal diameters, areas, and residual rims being recorded. Adequate 3D TEE imaging data sets were collected and then analyzed. ASD related parameters were compared using different echocardiography. Patients who underwent ASD closure completed a clinical follow-up.ResultsThe mean defect maximal diameter and aperture area by 3D TEE was significantly larger than that of the corresponding 2D TEE (P<0.05). There was no statistical difference in the minimal and maximal diameter or area by TEE for circular-shaped ASDs. For oval ASDs, mean minimal diameter on 2D TEE was larger than that on 3D TEE. The mean maximal diameter measured using 2D TEE was smaller than the 3D TEE measurement (16.0±7.1 vs. 19.8±8.6; P<0.05). For complex-shaped defects, there were statistical differences in minimal and maximal diameter between TEEs. Furthermore, 2D and 3D TEE had a longer superior vena cava (SVC) residual rim than did 2D TTE (P<0.05). The 3D TEE residual rims of the inferior vena cava (IVC) was significantly larger than the corresponding 2D TEE. There was a very strong correlation between the residual rim measurements using 3D and 2D TEE. However, the limits of agreement between 2D and real-time 3D TEE measurements were more apparent in the IVC rim group than in the other groups.ConclusionsOur study confirms the value of 3D TEE in assessing ASD shape and size reported by previous studies, and is also the first to accurately and systematically characterize ASD residual rim in complex ASDs.

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

BackgroundTranscatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age.MethodsFrom September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively.ResultThe mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up.ConclusionTranscatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.

Silikon Protez Kullanılarak Rekonstrüktif Meme Cerrahisi Uygulanmış Hastada Minimal İnvaziv Sinüs Venozus Defekti Onarımı

Atrial septal defect is one of the most common congenital cardiac anomalies in adulthood. Advances in minimally invasive surgical approaches result in an increased use of these techniques in selected patients. Atrial septal defect closure with minimal invasive surgery through right anterior thoracotomy is one of the first chosen treatment methods with reliable results and high patient satisfaction especially in young ladies. In this paper, we present the repair of sinus venosus defect with minimal invasive methods in a patient whom underwent breast reconstruction using a silicone prosthesis three years ago. The operation through right anterolateral minithoracotomy approach was successful and cosmetically uneventful even in the presence of a complex atrial septal defect and the silicone breast prosthesis in the surgical area

P86Multimodality assessment of a complex atrial septal defect: each has an important role to play

P86Multimodality assessment of a complex atrial septal defect: each has an important role to play

Reduction of radiation exposure in transcatheter atrial septal defect closure: How low must we go?

Cardiac catheterization relies on X-ray imaging. Most procedures are now standardized. Interventionists must strive to minimize radiation exposure to reduce the risk of induced cancers. To describe the radiation level in our institution, and evaluate the components contributing to radiation exposure, during transcatheter atrial septal defect (ASD) closure. Radiation doses for ASD closure performed between January2009 and November2015 were reviewed retrospectively. Data on fluoroscopic time, dose area product (DAP), DAP/kg of body weight and total air kerma were collected. One hundred and seventy-four consecutive patients were included. Procedural success was 98.3%. Median procedural and fluoroscopic times were 15minutes and 1.2minutes, respectively. Median total air kerma, DAP and DAP/kg were 9.2mGy, 88.3μGy.m2 and 3.2μGy.m2/kg, respectively. Risk factors associated with higher DAP were older age, larger ASD and device, need for balloon calibration, occurrence of complications and use of higher frame rate. Reduction of frame rate to 7.5frames/second alone reduced by a factor of 2 the median DAP, DAP/kg and air kerma (99 vs 43μGy.m2, 3.5 vs 1.7μGy.m2/kg and 11 vs 4.8mGy, respectively; P<0.001). A low dose of radiation can be achieved for transcatheter ASD closure, even in complex ASDs, by following these recommendations: reduction of frame rate; avoidance of lateral view and cine acquisition; and limitation of fluoroscopic time by avoiding unnecessary manoeuvres and using echocardiographic guidance as much as possible.

TCTAP A-075 Transcatheter Closure of Complex Atrial Septal Defects: Morphological Predictors of Outcome with Modified Techniques of Device Deployment

TCTAP A-075 Transcatheter Closure of Complex Atrial Septal Defects: Morphological Predictors of Outcome with Modified Techniques of Device Deployment

Integrated 3D Echo-X-Ray Navigation Guided Transcatheter Closure of ComplexMultiple Atrial Septal Defects.

A 73-year-old women was referred to our institution for transcatheter closure of atrial septal defect (ASD). Three-dimensional transesophageal echocardiography (3D TEE) showed complex multiple ASDs of 26 mm (ASD1), 10 mm (ASD2), 8 mm (ASD3), and 15 mm (ASD4) ([Figure 1A][1]). We planned to close

Goose-neck snare-assisted transcatheter ASD closure: A safety procedure for large and complex ASDs.

To report on a new technique that increases the safety of percutaneous atrial septal defect (ASD) closure using a goose-neck snare system. ASD transcatheter closure is a widespread procedure. However, in some cases, ASDs may be large and with soft rims. In these situation, a potential risk exists for device malposition or embolization. When transesophageal echocardiography (TEE) evaluation and balloon sizing showed large defects with floppy rims the chosen Amplatzer device was implanted in a standard way. In large defects with floppy rims, before release a 5-mm goose-neck snare with its 4 Fr catheter was placed across the delivery cable and fixed to catch the screwing mechanism of implanted Amplatzer device. The delivery cable was unscrewed and the device reached its final position without any tension. If the position was considered satisfactory the device was released from the goose-neck snare. Thirteen patients had a snare-assisted ASD transcatheter closure. Median device size was 24 mm (range 14-38 mm). Retrieval or repositioning of the device using the goose-neck snare was performed in four cases: in three patients, because of device malposition after delivery cable release and in one patient, because of unsuitability of closure of a second significant defect. Furthermore, in two subjects with multiple ASDs, a second fenestration looked quite significant with the device still attached to the delivery cable while it appeared smaller after release. Snare-assisted Amplatzer ASD device placement is a new method for ASD percutaneous closure and adds safety to the procedure.

Comparison of Transcatheter Atrial Septal Defect Closure in Children, Adolescents and adults: Differences, Challenges and Short-, Mid- and Long-Term Results.

Background and ObjectivesThis study aims to compare the characteristics, effectiveness and results of transcatheter closure of atrial septal defect between children, adolescents, and adults.Subjects and MethodsIn this study, 683 patients who underwent atrial septal defect closure in the last 10 years were divided into three groups: children (age <12), adolescents (age 12 to 16), and adults (age >16) as group 1, group 2 and group 3, respectively.ResultsThe average defect size and incidence of complex atrial septal defect were higher in group 3 (p=0.0001 and 0.03 respectively). While the average size of the devic was higher in adults (22.6±6.4 mm vs. 18.5±4.9 mm; p=0.0001), the ratio of the device size/total septum was higher in both children and adolescents (Group 1 and 2). In the child and adolescent groups and patients with only complex atrial septal defect, the use of techniques, other than standard deployment, was similar in all three groups (p=0.86 and 0.41, respectively). The ratio of the residual shunt was similar in all three groups. Major complications were seen in 5 cases (4 cases with migration, and 1 case with dislocation) in group 3 and 1 case (migration) in group 1.ConclusionDepending on the complexity of the defect and age of the patient, transcatheter closure of atrial septal defect might have certain difficulties and complications. Patients must be evaluated in detail to avoid major complications and possible problems during the procedure.

The predictors of dislodgement and outcomes of transcatheter closure of complex atrial septal defects in adolescents and adults

ObjectiveTechnical difficulties still exist for the catheter closure of atrial septal defects (ASD) in some of the morphological features of defects, or hemodynamic features in the population. The morphological or hemodynamic features are (1) large ASD, (2) wide rim deficiency, (3) multiple defects, (4) severe pulmonary hypertension, (5) ventricular dysfunction, and (6) restrictive left ventricular compliance. Our study aimed to assess the efficacy of transcatheter closure of complex ASDs under transesophageal echocardiography (TEE) guidance in adolescents and adults, and figured out the predictors of atrial septum occluder (ASO) dislodgement. MethodsFrom June 2003 to June 2014, 125 adults and 12 adolescents were diagnosed with secundum ASD and underwent a transcatheter closure of defects using an ASO. Among the above patients, 63 patients had morphological or hemodynamic features that made ASD closure difficult. ResultsNo ASO dislodgement occurred in the non-complex ASD closure group, and an 88.9% success rate was observed in the complex ASD closure group. Higher Qp/Qs ratio, higher incidence of multiple ASDs, and larger ASD size in the complex ASD closure group were noted. 50.8% patients in complex ASD closure group had ASD≧30mm. Multivariate analysis demonstrated that an occurrence of eroded and IAS or aneurysm formation and arrhythmia during implantation were independent predictors for ASO dislodgement in complex ASD closure (p=0.005; p=0.037). ConclusionEroded and floppy IAS or aneurysm formation post ASO implantation and peri-procedure arrhythmia could predict ASO dislodgement in complex ASD closure. Transcatheter closure of ASDs under TEE guidance is feasible in complex cases.

Kompleks Atriyal Septal Defektlerin Perkutan Kapatılmasına Uygun Hasta Seçiminde Gerçek Zamanlı Üç Boyutlu Transözafajeal Ekokardiyografinin Rolü

Kompleks Atriyal Septal Defektlerin Perkutan Kapatılmasına Uygun Hasta Seçiminde Gerçek Zamanlı Üç Boyutlu Transözafajeal Ekokardiyografinin Rolü

Current perspectives in percutaneous atrial septal defect closure devices.

In the last decade, percutaneous atrial septal defect (ASD) closure has become the treatment of choice in most clinical presentations of ASD. Percutaneous ASD closure has established procedural safety through operator experience and improved device structure and deliverability. There have also been advances in diagnostic capabilities. Devices have evolved from large bulky meshes to repositionable, minimal residual mesh content that easily endothelializes and conforms well to surrounding structures. Biodegradable technology has been introduced and will be closely watched as a future option. The evolution of ASD closure device usage in the last four decades incorporates development that minimizes a wide range of serious side effects that have been reported over the years. Complications reported in the literature include thrombus formation, air embolization, device embolization, erosions, residual shunts, and nickel hypersensitivity. Modern devices have intermediate to long term data with outcomes that have been favorable. Devices are available in multiple sizes with improved delivery mechanisms to recapture, reposition, and safely close simple and complex ASDs amenable to percutaneous closure. In this review, commonly used devices and deployment procedures are discussed together with a look at devices that show promise for the future.