Closure of defects of the atrial septum in adults using the amplatzer device:100 consecutive patients in a single center

Abstract

SummaryBackground: Transcatheter device closure of atrial septal defects (ASD) is an alternative to surgery, but experience is limited in adults, especially in those with large (> 26 mm) defects.Hypothesis: We investigated the safety, efficacy, and learning curve for closure of ASD and patent foramen ovale (PFO) using the Amplatzer device.Methods: In all, 101 procedures were carried out in 100 consecutive adult patients in a single cardiac center between July 1998 and August 2002.Results: Preprocedure diagnosis was ASD and PFO in 50 patients each. A device was deployed in 94 of 101 attempts (93%) in 94 of 100 patients (94%). Atrial septal defect device sizes were 10-38 mm, median 24 mm, and 40% were > 26 mm. Major complications occurred in 2 of 100 patients (2%). One ASD device displaced requiring surgery within 24 h and one patient with PFO experienced pericardial tamponade; there were no deaths. Local vascular complications occurred in 4 of 100 (4%) and late complications in 4 of 100 (4%) patients. Patent foramen ovale closure was quicker (p < 0.001), required less radiation (p = 0.04), and was associated with fewer local vascular complications than ASD closure (p = 0.04). Deployment of ASD devices > 26 mm was not associated with increased complications, length of procedure, or radiation compared with devices ≤ 26 mm (all p > 0.05). Complications in the first 35 patients were more frequent than in subsequent patients: 7 of 35 (20%) versus 3 of 65 (4.6%) (p = 0.04); proce-

Echocardiographic Assessment of Percutaneous Patent Foramen Ovale and Atrial Septal Defect Closure Complications

“…Cardiac tamponade has been reported in approximately 0.5% to 1% of patients after ASD/PFO closure. 27,28 With device closure of ASD or PFO, tamponade most frequently results from perforation of the left atrial appendage during anchoring of the trans-septal guide wire. Less commonly, the right atrium, right ventricle, or right/left upper pulmonary vein may be the location of perforation.…”

Displaced atrial septal defect device retrieval — An interesting image

“…Complications following transcatheter closure are rare but include perforation and device embolisation. 1 In our case failure to deploy the device resulted in this unusual complication. …”

Secundum atrial septal defects: time to close them all?

“…Two large published series from the early days of catheter closure demonstrated complication rates from 4 to 8% 1 2. Other available datasets show a more realistic major complication rate of 1.6%3; however, this is still not a zero-risk procedure, and there is a steep learning curve for the operator 4. Complications include device embolisation, cardiac perforation, device thrombus, stroke, arrhythmia and serious vascular injury.…”