Percutaneous closure of atrial septal defect with the Amplatz device: Initial result and mid-term follow-up

Objectives. Percutaneous device occluslon of atrial septal defects (ASD) is , although with some limitations, an alternative to surgical closure. The a im of this study was to evaluate the efficacy and safety of percutaneous AS D closure using the Amplatz device. Patients and methods. From October 1999 to March 2000, 25 children underwen t transcatheter closure of ASD at a mean +/- SD age of 8.7 +/-3.1 years (ra nge 3-15 years) and a mean weight of 31.8 +/- 16.7 kg (range 11-84 kg). Dev ice selection was based on the stretched diameter of the ASD using the PTA OS balloon. The device was implanted under ultrasonographic and radiologica l guidance. All patients showed signs of volume-overload of the right ventr icle. The ASD was single (n=21), with two separate holes (n=2), or cribifor m; (n=2). Results. The median +/- SD size of the device used was 21.7 +/-5.4 mm (rang e 15-36 mm). In twenty-two patients (88%) the device was successfully impla nted. A repeat echocardiogram was performed the next day before discharge. Two patients underwent surgery after deployment of the device due to mitral valve dysfunction (n=1) or residual leak (n=1). In a patient with a two-ho le ASD, another device was percutaneously withdrawn, while still attached t o the delivery cable due to incomplete occlusion. Conclusions. a) Transcatheter occlusion with the Amplatzer device is an eff ective treatment for ostium secundum atrial septal defects; b) the low comp lication rate and the short hospitalization period makes this procedure the treatment of choice in these patients, and c) ASD which are too large, cri biform or with deficient rims may require a different approach.