<![CDATA[<b>Cardiopatias cong�nitas</b>]]>

Abstract

Percutaneous closure (PC) of secundum atrial septal defects (ASD) has been performed safely and effectively. We report our experience with this procedure in patients (pts) with complex defects. From 9/97, 110 pts underwent ASD closure under general anesthesia and transesophageal echocardiographic guidance. Thirty pts (median age: 26 yrs) had complex anatomy defined as large defects (stretched diameter (SD) > 26mm) associated with 1 deficient rim (<4mm) or aneurysm of the atrial septum (20), and multiple defects or fenestrated septum (10). The median SD diameter was 27mm. Amplatzer devices were used in all but 1 pt. Two pts required 2 devices due to distant holes. The remaining with multiple/fenestrated defects received a single device. Modifications in the standard technique were required in some pts. Failures occurred in 3 pts with no anterior rim and a floppy postero-inferior rim. In 1 pt, a 30mm Amplatzer protruded towards the right atrium, was snared out of the body and exchanged for a 32 device. Mean procedure time was 100 minutes. Residual leaks were observed in 10/27 pts immediately after implantation. There was no major complication and all pts, except 1, were discharged the following day. In a mean follow-up of 12 mos, 2/27 pts (both asymptomatic) remained with residual leaks <4mm despite normal right ventricular dimensions. Despite being technically demanding, PC of complex ASDs can be performed safely and effectively. Pts with large defects associated with no anterior rim and a floppy posteroinferior rim were considered to have unsuitable anatomy for PC. OCLUSION PERCUTANEA DE LA COMUNICACION INTERAURI-CULAR (CIA). TIPO OSTIUM SECUNDUM