Transcatheter closure of atrial septal defect in adults: practicability and safety of four different occluder systems used in 102 patients

Background and objective: Surgical closure of secundum atrial septal defect (ASD) or patent foramen ovale (PFO) is a procedure with few complications. But this surgical intervention can nowadays be avoided by transcatheter in sertion of occluding devices. Such interventional methods must be judged ag ainst the results of surgical procedures. This report from one center prese nts the practicability and safety of different transcatheter occluder syste ms. Patients and methods: Transcatheter occlusion was undertaken in 102 patient s (40 females, 62 males, aged between 17 and 76 years [median age 45]) with either an ASD (41 pts.) or a PFO (60 pts.) or with both, in one patient. F our different systems were used: ASDOS((R)) (for ASD and PFO), PFO-STAR((R) ) (for PFO), Amplatzer((R)) Septal Occluder (for ASD) or Amplatzer((R)) PF0 Occluder (for PFO). Follow-up, including transoesophageal echocardiography took place 48 hours, 4 weeks, 6 months and 1 year after the interventional occluder placement. Results:An occluder was successfully placed in the ASD or PFO. in 99 of the 102 patients. In three patients the occluder (ASDOS((R)) ASD) could not be correctly ancchored in the defect. In two other patients the same device w as subsequently removed surgically because of mispositioning or a large res iudal shunt. Occluder-associated problems were: mild (41%) or extensive (11 %) thrombus formation on the occluder without early embolization, residual shunt at one year (ASD 16%, PFO 29%); minor displacement (10%) or broken um brella strut (6%) of no clinical relevance. One patient required emergency surgical intervention on the day of the transcatheter placement (PFO-STAR(( R))) because of pricardial tamponade. Primary complete occlusion was achiev ed in 71%. There was no case of cerebral emboli. Conclusion:Transcatheter occlusion of ASD and/or PFO is a reliable and safe procedure. Regarding peri-and/or postinterventional complications, primary results and practicability, the Amplatzer septal occluder and Amplatzer PF O occluder are particularly advantageous.