TRANSCATHETER CLOSURE OF ATRIAL SEPTAL-DEFECTS BY THE BUTTONED DEVICE- COMPLICATIONS AND NEED FOR SURGICAL REVISION

Immediate and medium-term experience with transcatheter closure of a s ecundum atrial septal defect by the ''buttoned'' device in seven patie nts is reported. Complications occurred in two patients during the pro cedure. In one patient with complications, the occluder was partly rel eased in the right atrium. All efforts to correct its position were un successful and caused considerable deformation of the device, which ha d to be removed surgically. In the other patient with complications, d isconnection of the occluder and counteroccluder occurred immediately after removal of the loading wire. Both parts were retrieved by cathet er. Five patients had uneventful closure of the atrial septal defect. On followup, however, displacement of the device towards the mitral va lve was observed in two patients, which caused mitral regurgitation. S urgical removal of the device and repair of the mitral valve was neces sary in both patients. Two years after the procedure, the atrial septa l defect was closed completely in two of the remaining three patients and a small residual defect persisted in one patient.