Transcatheter closure or secundum atrial septal defects with the Amplatzerseptal occluder: Early experience

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.