LATE COMPLICATIONS OF PERCUTANEOUS CLOSUR E OF ATRIAL SEPTAL-DEFECTS WITH THE SIDERIS OCCLUDER

Between June 1992 and January 1996, 27 patients aged 3.9 to 74 years w ith an ostium secundum (22 patients) or patent foramen ovale with righ t-to-left shunts (5 patients) underwent percutaneous closure of their atrial septal defects with the Sideris occluder. After a thromboemboli c complication, transesophageal echocardiography was performed routine ly after the procedure in 15 patients between 1 month and 2 years, and in 6 patients on the 15 th day. Two patients died, on the 2nd day and 21st month, of non-related causes. After an average follow-up of 33 m onths, 59 % of patients had complete occlusion of the atrial septal de fects or only a minimal residual shunt. Displacement of the prosthesis was defects or only a minimal residual shunt. Displacement of the pro sthesis was observed in 7 cases with no relationship to size : 4 paral lel to the septum with reappearance or increase in shunt, 3 with tilti ng of the prosthesis. All of these patients had a large residual defec t compared with 20 % with a normally positioned prosthesis (p < 0.05). Tilting of the occluder was associated with left atrial thrombosis (p resent in 40 % of these patients), complicated by systemic embolism in one case; there were no cases of left atrial thrombus in the 9 with c omplete occlusion and the 5 patients with an isolated residual defect (p < 0.05). Occlusion of atrial septal defect with the Sideris device is effective and a safe method in the majority of cases. However, a ba dly positioned prosthesis with a residual shunt should be extracted as seen as possible or within three weeks if displacement is observed at control echocardiography.