The Amplatzer septal occluder

The Amplatzer Septal Occluder is made from a Nitinol wire mesh shaped into 2 disks with a connecting waist, which serves to center the device in the d efect while occluding it. The Amplatzer device is also available in a confi guration with no central waist for use in patients with patent oval foramen , or multiperforated aneurysm of the interatrial septum. For the purposes o f this review, we analysed our experience using the Amplatzer device in 150 patients with interatrial communications. Of these, 104 had a defect withi n the oval fossa, 33 a patent oval foramen, and 13 had undergone fenestrati on of a Fontan procedure. Of those with defects within the oval fossa, a de vice was implanted in 100 patients, and 2 of these patients subsequently re quired surgical intervention, 1 because of migration and the other because of malformation of the device. Of the remaining 98 patients, complete occlu sion has been achieved in 90% at 1 year. Any residual leaks are either triv ial or small. In those with a patent oval foramen, the septal occluder was used to close 20, whilst the device designed specifically for this purpose was used in 13. On follow-up contrast echocardiography, only 2 patients hav e a small residual right-to-left shunt. Complete occlusion was achieved for all the Fontan fenestrations, although 1 patient later underwent surgery f or baffle dehiscence. Other significant complications occurred in 2 patient s who developed deep vein thrombosis, and 3 patients who suffered transient supraventicular arrhythmias. Although the Amplatzer device has been in cli nical use for only 3 years, its unique design, and ease of use, has resulte d in its widespread adoption by many centres. The results to date are very encouraging, but it must be remembered that there is, as yet, no long-term followup data available for this life-long implant.