Device closure of diverse layout of multi-hole secundum atrial septal defect: different techniques and long-term follow-up

Abstract

Background There are no unanimous reports on different layouts and classifications of multi-hole secundum atrial septal defects (MHASD) and subsequent standardized occlusion techniques. The MHASD can be isolated or cribriform with variable inter-defects distance. In this retrospective study, experience-based classification and two approaches-based occlusion results are presented. Methods We retrospectively collected and analyzed data of 150 MHASD patients from 1320 patients who underwent atrial septal defect occlusion in our institute. The MHASD patients were categorized into 4 types; type A, B, C and D and occluded under exclusive transesophageal echocardiographic guidance. According to different types, 122 patients were occluded using peratrial approach and 28 patients via percutaneous approach. In type A, single device implantation is performed to occlude the large hole and squeeze the small one. For type B single or double-device deployment was performed depending on an inter-defects distance. In type C and D, a patent foramen-ovale (PF) device was selectively positioned to the central defect to occlude the central defect and cover the peripheral ones. In peratrial approach, 8 patients underwent inter-defects septal puncture technique to achieve single-device occlusion. The intracardiac manipulation time, procedural time, double device deployment, redeployment rate, residual shunt, and proportions were analyzed between (and within peratrial technique) two techniques. Results Successful occlusion was achieved in all 150 patients. Single device occlusion was applied in 78/84 type A and 22/37 type B patients ( p < 0.05). Double device occlusion was more applicable to type B than A patients ( p < 0.01). Sixteen of 21 type C and all type D patients used PF device for a satisfactory occlusion. Redeployment of the device occurred frequently in type B patients than A ( p < 0.01). The intracardiac manipulation time and procedural time were shorter in type A than B ( p < 0.05). The intracardiac manipulation time was also shortened in type A peratrial than type A percutaneous group ( p < 0.05). Complete occlusion rate for all patients at discharge was 70% and rose to 82% at 1 year follow up. Conclusions The diverse layouts and classification of MHASDs can help to choose different techniques and proper devices of different kinds to achieve better occlusion results.

Outcomes of Device Closure of Atrial Septal Defects

“…92% of patients had a complete occlusion of the defects at six and 12 months after the procedure [ 91 ]. Other investigators documented similar encouraging results [ 92 , 93 ]. The author’s personal experience with this device was limited but successful ( Figure 14 and Figure 15 ).…”

“… * Results of studies in children [ 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ] and adults [ 61 , 64 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 ] including FDA-approved US trial [ 80 ] and multi-institutional European studies [ 70 , 81 ] were reviewed and tabulated elsewhere [ 20 , 21 , 47 , 82 ]; # Similar results [ 92 , 93 ] were seen in other studies; ! Studies in children and adults [ 102 , 103 , 106 ] were similar; @ Similar results were reported in single institutional [ 107 , 108 ] and Canadian [ 109 ], European [ 110 , 111 ] and US [ 112 ] multi-institutional studies.…”

Individualized Experience With Percutaneous Transcatheter Closure of Multiple Atrial Septal Defects: A Single-Center Study

“…Of our 50 cases, four patients had RS immediately after surgery, with only one patient still having RS after the last follow-up, providing a closure rate of 98%. Farhaj et al reported on 150 multiple ASDs patients who underwent transcatheter closure, with 58 (38.7%) of the patients having immediate RS, and the complete closure rate was 80% at the 12-month follow-up ( 2 ). Even though RS was inevitable, Veldtman GR report that if the width of RS<3 mm, cardiac function recovered, murmur disappeared, the heart structure could be recovered, it is unnecessary for secondary closure ( 17 ).…”

“…The IDD was defined as the distance from the central defect (implanting hole) to the surrounding hole, which needed to be covered. The ASA met the following criteria ( 4 , 5 ): ( 1 ) the width of the aneurysmal base is more than 15 mm; ( 2 ) the excursion of ≥10 mm into the double atrium or the sum of bilateral excursion of >10 mm.…”

“…Farhaj et al reported on 150 multihole secundum ASD patients who underwent treatment with different techniques and devices and achieved good results. They reported that the immediate complete closure rate was 61.3% and that the sixth-month complete closure rate was 77.2% ( 2 ). Many closure strategies and different devices have been used, but there were fewer reported with a higher complete closure rate ( 3 ).…”