Outcomes of Device Closure of Atrial Septal Defects

Abstract

Several devices have been designed and tried over the years to percutaneously close atrial septal defects (ASDs). Most of the devices were first experimented in animal models with subsequent clinical testing in human subjects. Some devices were discontinued or withdrawn from further clinical use for varied reasons and other devices received Food and Drug Administration (FDA) approval with consequent continued usage. The outcomes of both discontinued and currently used devices was presented in some detail. The results of device implantation are generally good when appropriate care and precautions are undertaken. At this time, Amplatzer Septal Occluder is most frequently utilized device for occlusion of secundum ASD around the world.

Role of Echocardiography in the Diagnosis and Interventional Management of Atrial Septal Defects

“…Echocardiographic examination is useful in demonstrating the position of the device. In the majority of patients, excellent position of the device immediately following ( Figure 29 , Figure 30 , Figure 33 , Figure 34 , Figure 35 , Figure 39 and Figure 40 b), at short-term ( Figure 40 c and Figure 41 ) and long-term ( Figure 42 and Figure 43 ) follow-up with all the devices examined [ 7 , 36 , 37 , 60 ] can be demonstrated. No residual shunt was seen on color Doppler ( Figure 44 ) in most patients [ 7 , 36 , 37 , 60 ]; residual shunts will be reviewed in the next section.…”

“…However, the newest software allows one to demonstrate 3D images during the initial recording of the images. Nonetheless, the high device implantation rates (88 to 94%) [ 36 , 37 ] without the use of 3D echo lead the author to recommend that regular use of 3D is not needed; however, it might be used in patients with bizarre-shaped ASDs and those defects that have deficient septal rims [ 38 ], either on TTE or TEE studies.…”

“…With the Amplatzer device, residual shunts have been reported in 4 to 38% at device implantation, which decreased to 1 to 17% at 6- to 12-month follow-up [ 37 ]. In our own study [ 4 , 63 ], 16% of patients had trivial-to-small residual shunts at the completion of ASD device implantation.…”

“…Ao, aorta; LA, left atrium; RA, right atrium; SVC, superior vena cava. Reproduced from reference [ 37 ].…”

Commentary: Less-invasive atrial septal defect closure can become more invasive

“…However, at this time the Amplatzer nitinol mesh devices and the Gore expanded polyterafluoroethylene membrane devices (W. L. Gore & Associates, Inc, Flagstaff, Ariz) are the only devices approved for ASD closure by the US Food and Drug Administration in the United States. 5 Until improved designs become available, it is important to select patients for percutaneous ASD closure as suggested by Kitamura and colleagues. 3 Otherwise, these less-invasive percutaneous devices risk complications that require further invasive procedures.…”