Transcatheter Closure of Atrial Septal Defects by the “Buttoned” Device: Complications and Need for Surgical Revision

Abstract

Immediate and medium-term experience with transcatheter closure of a secundum atrial septal defect by the "buttoned" device in seven patients is reported. Complications occurred in two patients during the procedure. In one patient with complications, the occluder was partly released in the right atrium. All efforts to correct its position were unsuccessful and caused considerable deformation of the device, which had to be removed surgically. In the other patient with complications, disconnection of the occluder and counteroccluder occurred immediately after removal of the loading wire. Both parts were retrieved by catheter. Five patients had uneventful closure of the atrial septal defect. On follow-up, however, displacement of the device towards the mitral valve was observed in two patients, which caused mitral regurgitation. Surgical removal of the device and repair of the mitral valve was necessary in both patients. Two years after the procedure, the atrial septal defect was closed completely in two of the remaining three patients and a small residual defect persisted in one patient.

Partial prolapse of a HELEX device associated with early frame fracture and mitral valve perforation

“…Interference with mitral valve function and even structural damage to the mitral valve has been reported with atrial septal occluder devices [4–6]. To our knowledge, the case detailed in this report is the only case of HELEX device fracture resulting in perforation of a valve leaflet.…”

Experience in one centre using the buttoned device for occlusion of atrial septal defect: comparison with the Amplatzer septal occluder

“…One of the major concerns for the buttoned device is the correct positioning of the occluder through the defect. 12 Indeed, several obturators were used in 24 of the 73 patients before we could achieve adequate placement. This gives a ratio of 1.3 occluder per patient for both groups.…”

Aortic sinus-left atrial fistula after interventional closure of atrial septal defect

“…The complication rate seems to be quite low, comparable to surgical results [7, 8]. Nevertheless, embolic events, arrhythmias, infection, thrombus formation, transient ischemic attack, and transient repolarization disorders may occur [5, 6, 9–12], requiring surgical management [13, 14]. Perforation of the left atrium resulting in a fistula from the left atrium to the aortic sinus is described in this case report.…”