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

Abstract

Multiple atrial septal defects (ASDs) are one type of secundum ASD, most of which have an atrial septal aneurysm or long interdefect distance. In our retrospective single-center study, we reviewed different closure strategies for multiple ASDs. We analyzed 50 patients who underwent percutaneous transcatheter closure from May 2011 to July 2019. Information on the patients' characteristics, operation procedure, occluder selection, and complications was collected. According to the feature of the defects and device choice, multiple ASDs were divided into five groups. A successful operation was achieved in every patient. A total of 50 patients were implanted with 58 devices, with 26 patients implanted with a single standard ASD occluder (ASDO); six patients were implanted with double standard ASDOs, and only one patient was implanted with three standard ASDOs. There were 17 patients whose closure was made using the small-waist–big-edge ASDO. Seventy-six percent of the patients (38/50) had an immediate residual shunt. During the mean follow-up of 25.76 ± 22.53 months, the complete closure rate was 92%. Except for two patients with a transient atrioventricular block, individualized experience with percutaneous transcatheter closure for multiple ASDs was effective in a single-center study. After a mid- to long-term follow-up, the multiple ASDOs and small-waist–big-edge ASDO had no serious adverse events or complications.

Balloon Interrogation of Intervening Tissue: A Novel Method to Decide Strategy for Closing Multiple Atrial Septal Defects

“…In the earlier studies, the operators have oversized the device by 6 to 9 mm (which is 25%–40% more than the defect size) to cover both the defects. 9,10 In that sense, oversizing in the present study is not significantly different from the one previously reported. On the contrary, we believe, that not attempting to stretch the intervening tissue and going by the BSD using stop flow technique may result in significant under sizing of the defect with high chances of device embolization and without a chance to adopt a single device strategy.…”

“…9,19 Others used a distance of >12 mm with inadequately mobile intervening tissue to consider a 2-device strategy by using devices with a 12 mm overhang of the LA disc. 10 However, none of them defined a technique of assessing the mobility as was done in this study. These previous recommendations, therefore, appear empirical and an oversimplification of a much complex problem.…”

Filling the Holes of a Swiss Cheese Atrial Septal Defect: A Case Report and Review of the Literature

“…4 However, percutaneous transcatheter approach is challenging with additional structural limitations of atrial septal aneurysm, deficient ASD rims, and long inter-defect distances. 1 The atrial septal aneurysm may not provide sufficient rims for implantation of standardized ASD occluder and complete closure without residual shunts is difficult to achieve without the use of multiple devices. 1 Current literature supports that a single cribriform device is preferred as the large discs stabilizes the aneurysmal septum, and the device itself does not rely on the septum for position stability.…”

“…1 The atrial septal aneurysm may not provide sufficient rims for implantation of standardized ASD occluder and complete closure without residual shunts is difficult to achieve without the use of multiple devices. 1 Current literature supports that a single cribriform device is preferred as the large discs stabilizes the aneurysmal septum, and the device itself does not rely on the septum for position stability. 2,5 Cribriform ASO device is available in 18-, 25-, or 35-mm sizes and its use had successfully repaired 13 out of 16 cases of fenestrated ASD with aneurysmal atrial septum in one study.…”

“…the risk of arrhythmia and thromboembolic events. [1][2] Detailed anatomy of the interatrial septum through 2D and 3D imaging serves as diagnostic and therapeutic guidance. 3 We describe a case of Swiss Cheese ASD complicated with an atrial septal aneurysm successfully repaired with a Cribriform Amplatzer Septal Occluder (ASO) via percutaneous transcatheter approach.…”