A. Matitiau et al., Transcatheter closure or secundum atrial septal defects with the Amplatzerseptal occluder: Early experience, ISR MED ASS, 3(1), 2001, pp. 32-35
Background: Secundum atrial septal defect is a common congenital heart defe
ct that causes right heart volume overload and produces symptoms usually af
ter the third decade of life. Treatment until the last few years has been o
pen heart surgery.
Objectives: To review our early experience with transcatheter closure of AS
D2 using the Amplatzer septal occluder.
Methods: Between November 1999 and February 2000, 20 children and young adu
lts with a median age of 9.1 years (4.2-35.1 years) were referred for trans
catheter closure of ASD2. Diagnosis was established by transthoracic echoca
rdiography. Implantation was performed under general anesthesia through the
femoral vein with the guidance of transesophageal echocardiography and flu
oroscopy. Femoral arterial puncture was performed for blood pressure monito
ring during the procedure, The device size chosen was similar to the balloo
n-stretched diameter of the ASD2.
Results: Implantation was completed successfully in 18 patients. Two patien
ts were referred for elective surgery: one had an unsuitable anatomy for tr
anscatheter closure by TEE in the catheterization laboratory and the device
could not be implanted properly, the other patient had a large multi-perfo
rated septal aneurysm that was retrieved. Mean ASD2 diameter by TTE and TEE
was similar (13.9 +/- 3 mm, 13.4 +/- 3.5 mm) and mean stretched diameter w
as 18.3 +/- 4.3 mm. Mean Op:Qs (pulmonary flow:systemic flow) was 2.2 +/- 0
.6. Mean fluoroscopy time for the procedure was 14.8 +/- 4.8 minutes. The p
atients were discharged the day after the procedure. Four patients had a ti
ny leak immediately post-procedure, and none had a leak at one month follow
-up. The only complication was a small pseudoaneurysm of the femoral artery
in one patient, that resolved spontaneously.
Conclusions: Transcatheter closure of ASD2 with the Amplatzer septal occlud
er is a safe and effective alternative to surgical closure. Long-term outco
me has to be evaluated.