Percutaneous closure with Amplatzer device is a safe and efficient alternative to surgery in adults with large atrial septal defects

Background In adults with atrial septal defect (ASD) and large right-to-lef t shunt, closure of the defect is recommended. Percutaneous closure is stil l rarely used in this population. This study presents the results of transc atheter closure with the Amplatzer occluder in such patients. Methods and Results We studied 44 consecutive adult patients with a secundu m ASD and 2 of the 3 following criteria: QP/QS greater than or equal to2 by oximetry, echocardiographic right ventricle overload, and ASD size >20 mm. Forty-two patients had a successful implantation. In 1 patient an unstable device was withdrawn; in another one, the device embolized in the pulmonar y artery. At 6-month median follow-up, 95% had a complete closure; 2 patien ts with an additional defect had a small residual shunt. Major complication s were the aforementioned embolization and a cerebrovascular accident in a patient with atrial fibrillation treated with aspirin. Others were minor an d transitory: premature atrial beats in 3 patients, and paroxysmal atrial f ibrillation and pulmonary edema in 1 patient each. Conclusions Transcatheter closure of large ASDs with the Amplatzer device i s efficient with less morbidity than surgical closure.