Outcome of Transcatheter Closure of Oval Shaped Atrial Septal Defect with Amplatzer Septal Occluder

Abstract

PurposeFor the successful completion of transcatheter closure of atrial septal defects with the Amplatzer septal occluder, shape of the defects should be considered prior to selecting the device. The purpose of this study is to evaluate the results of a transcatheter closure of oval shaped atrial septal defect.Materials and MethodsFrom November 2009 until November 2011, cardiac computed tomography was performed on 69 patients who needed a transcatheter closure of atrial septal defect. We defined an oval shaped atrial septal defect as the ratio of the shortest diameter to the longest diameter ≤0.75 measured using computed tomography. A trans-thoracic echocardiogram was performed one day after and six months after.ResultsThe transcatheter closure of atrial septal defect was performed successfully in 24 patients in the ovoid group and 45 patients in the circular group. There were no serious complications in both groups and the complete closure rate at 6 months later was 92.3% in the ovoid group and 93.1% in the circular group (p>0.05). The differences between the device size to the longest diameter of the defect and the ratios of the device size to the longest diameter were significantly smaller in the ovoid group (1.8±2.8 vs. 3.7±2.6 and 1.1±0.1 vs. 1.2±0.2).ConclusionTranscatheter closure of an oval shaped atrial septal defect was found to be safe with the smaller Amplatzer septal occluder device when compared with circular atrial septal defects.

The relation between atrial septal defect shape, diameter, and area using three-dimensional transoesophageal echocardiography and balloon sizing during percutaneous closure in children

“…An alternative method using a static balloon was developed. 13,20,25 Our results may have been impacted by the pullthrough balloon method used to calibrate the ASD. The formulas we suggest to predict BS may not be accurate with this alternative balloon technique.…”

“…There is no recommended threshold and other authors used a 1.33 value. 20 We demonstrated that the visual analysis is closer to a circular index threshold of 1.4. Our study further allows estimating BS using the 3D maximal ASD diameter with a correction factor according to the shape of the ASD.…”

“…Some authors moved towards and device selection without BS has already been safely performed. 20,28,29 Our work has several limitations. Patients with multiple holes were excluded.…”

“…BS was performed using the 'pullthrough' technique with the Meditech Equalizer balloon catheter (Boston Scientific, Natick, MA, USA). 13 The chosen occlusion balloon diameter (20,27,33, or 40 mm) was only slightly larger than the 2D-TEE ASD maximal diameter . The occlusion balloon was manually inflated into the left atrium filled with diluted contrast.…”

Comprehensive understanding of atrial septal defects by imaging studies for successful transcatheter closure

“…It is not surprising that many ASDs are not circular in shape, and indeed complex ASD shapes have been described by some authors16,19,20,21,22,23). Three-dimensional (3D) images should be reconstructed from 2D images for a complete understanding of defect shape.…”