SURGICAL EXPLANTATION OF SIDERIS TRANSCAT HETER DEVICES FOR ATRIAL SEPTAL CLOSURE-15 AND 376 DAYS AFTER IMPLANTATION

The theoretical advantages of the transcatheter closure of atrial sept al defects are overshadowed by the presently known complications. From the 3 devices used in clinical trials: Rashkind, Lock Clamshell and S ideris, only the Sideris ''buttoned'' intracardiac occluder (Custom Me dical Devices, Amarillo, Texas) can be implanted via an 8F sheat, thus making transcatheter ASD closure possible in very young infants. Unfo rtunately this device shows and inadequate rate of improper position a nd dislocations. Thereto we report 2 cases of surgical device removal 15 and 376 days after implantation. In both cases, the devices showed a total incorporation into the atrial wall with complete endothelializ ation. Thus big areals with defect endothelization remained in the atr ium after explantation. In one case, the mitral valve showed a lesion at the posterior leaflet and needed to be repaired. Because of our exp erience in these cases, we strongly recommend quick explantation of im proper implanted devices and a critical revision of the indications fo r transcatheter atrial closure.