Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer ™ Septal Occluder

Abstract

To judge whether an Amplatzer™ Septal Occluder can be used as standard therapy instead of surgery for closure of atrial septal defects we report our experiences in 200 patients. Of these patients, 127 had an atrial septal defect with haemodynamically significant left-to-right shunt, 68 patients a persistent oval foramen after presumed paradoxical embolism, and 5 had a fenestration after Fontan-repair. Mean age was 29.8 years (0.8 to 77.7 years). Body weight ranged from 6.9 to 120.0 kg (mean 51.5 kg). After diagnostic cardiac catheterization, and balloon-sizing of the defect, we implanted Amplatzer™ Septal Occluders with stents of 4 to 28 mm diameter. Follow-up studies were obtained after 48hours, and one, six, and twelve months. Transcatheter closure of the atrial septal defect proved successful in all without any relevant residual shunts. In particular, complete closure was achieved in all patients after presumed paradoxical embolism. The mean period of follow-up is 9–5 months, with a range from 0.4 to 23.5 months, giving a total of 1898 patient months. The occlusion rate after three month was 98.1°. A trivial haemodynamically insignificant residual shunt remained in 1.9° of the patients. Fluoroscopy times ranged from 0 to 43.5 minutes, with a median of 8.7 minutes. The excellent results in the short and medium term in children and adults have resulted in using this device routinely at the present time for closure of central atrial septal defects up to a diameter of 28 mm. Final judgement, however, is only possible after long-term follow-up.

Congenital heart defects in Kabuki syndrome

“…With the development of various closure devices, percutaneous atrial septal defect closure can be accomplished interventionally in selected patients [30]. Mini-thoracotomy, min-sternotomy and video-assisted thoracoscopy have also been utilized as minimally invasive surgical techniques in the repair of simple congenital heart defects and other heart operations [31].…”

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

“…8,9,13,15,16,18,19,22,25,26,28 Earlier case series using Amplatzer devices, for example those undertaken by Berger et al 18 inevitably used smaller device diameters because larger devices only became available subsequently and the case mix was pediatric and adult. This study is important, however, as it directly demonstrates that larger devices, even up to 38 mm diameter, can be safely implanted without significantly increasing fluoroscopy time, procedure time, or risk of complications compared with smaller devices.…”

“…8,9,[12][13][14][15][16][17][18][19][20][21][22][23][24] The Amplatzer occluder is a second generation self-centering device which is a widely accepted treatment for ASD and PFO. 18,19 Clinical experience with the Amplatzer devices is relatively limited in adults, particularly in those with large defects (> 26 mm in diameter), which are uncommon in published series. 3, 9, 10, 13, 15-17, 20, 22, 25, 26 As transcatheter ASD closure has become more widely practiced, more institutions will likely undertake relatively few cases.…”

Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects

“…In the last 10-15 years, major advances in the percutaneous treatment of atrial septal defects with the use of several occluding devices has occurred with progressive improvement in the results [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . Because this approach currently provides excellent occlusive results with minimum morbidity and mortality in short and medium follow-up with obvious advantages regarding the surgical approach [8][9][10][11][12][13][14][15][16][17] , it is considered the method of choice for the treatment of selected patients in several medical centers around the world.…”

“…Because this approach currently provides excellent occlusive results with minimum morbidity and mortality in short and medium follow-up with obvious advantages regarding the surgical approach [8][9][10][11][12][13][14][15][16][17] , it is considered the method of choice for the treatment of selected patients in several medical centers around the world. However, some devices have not been widely accepted by interventionists because they possess characteristics far from those considered ideal [1][2][3][4][5][6][7] .…”