Transcatheter occlusion of complex atrial septal defects

Percutaneous device occlusion of secundum atrial septal defects (ASDs) is b ecoming an accepted alternative to surgical closure. This method allows us to evaluate patients with complex conditions for treatment. From a total of 70 patients with ASD evaluated for percutaneous closure, we selected for a nalysis 28 who had complex conditions. The mean age was 36 +/- 23 yr (range , 4-72). Six had heart failure, and of these six, three had atrial fibrilla tion. At cardiac catheterization, the pulmonary pressure was 47 +/- 24 mm H g, and the QP/QS was 1.7 +/- 0.4; two patients had bidirectional shunt and systemic pulmonary pressure. Two patients received a buttoned device and 26 an Amplatzer septal occluder, The groups of patients with complex conditio ns were separated into the following groups. Group I (n = 4) underwent comb ined treatment of associated anomalies. Two patients had pulmonary stenosis , one had mitral stenosis, and one had an aortic root-left atrium fistula. They were treated in or during with the same procedure by combined transcat heter techniques (balloon valvuloplasty and fistula occlusion) before ASD o cclusion. Group II (n = 9) had multiple defects (cribiform or two separate holes). They were treated with a single device in five instances and with t wo separate devices in four cases. Group III (n = 14) had large (32 +/- 3 m m) single defects, Nine of them underwent successful implantation using a d evice 33 +/- 3 mm in diameter; in the remaining five patients the device wa s removed because of instability. Group IV (n = 3) had residual defects aft er previous partial device occlusion. All three defects were successfully o ccluded with a second device. No movement or interference with the first de vice was observed. Group V (n = 6) had severe pulmonary hypertension (86 +/ - 16 mm Hg). Immediately after ASD occlusion we observed significant relief in these patients (67 +/- 14 mm Hg; P < 0.01). There were no major complic ations; all 23 patients with successful implants were discharged without sy mptoms 2-7 days later; one patient with atrial fibrillation recovered sinus rhythm. The follow-up (8 +/- 5 mo) Doppler echo study showed complete ASD occlusion in 22 patients and 8 peak pulmonary pressure of 30 +/- 14 mm Hg, We conclude that transcatheter occlusion of ASDs is an effective and safe t reatment for patients with complex anatomic or physiopathologic conditions, as evaluated by shortterm follow-up. Cathet. Cardiovasc. Intervent 51:33-4 1, 2000. (C) 2000 Wiley-Liss, Inc.