Transcatheter closure of double atrial septal defects with a single Amplatzer device

Abstract

Transcatheter closure of single secundum atrial defects has become the standard of treatment. The purpose of our study was to analyze the results of using a single Amplatzer device for closure of double atrial septal defects. Such defects were diagnosed in 41 out of 363 patients with atrial septal defects (ASDs) closed by transcatheter method. In 39, a single Amplatzer device was used. The size of the larger defect ranged from 5 to 18 mm, the smaller defect from 2 to 7 mm, with the distance between the borders of the communications ranging from 2 to 12 mm. We performed sizing and closure of only the larger defect. The mean size of implanted devices was 16.5 +/- 5.5 mm, equal to the stretched diameter of the main defect or 1-4 mm larger. The closure rate assessed by color Doppler flow examination was 61% after 24 hr, 78% after 1 month, 83% after 3 months, 86% after 1 year, and 95% after 2 years. If the distance between the two defects exceeded 7 mm, residual leaks were observed but tended to decrease and disappear with time. Selected patients with double atrial septal defects can be effectively treated with implantation of a single Amplatzer device.

Intra-operative device closure of multiple atrial septal defects facilitated by a unique atrial septum remodeling technique: initial results and experience in 11 patients

“…Data about the feasibility and efficacy of using transcatheter approach to close the multiple ASDs are limited [3][4][5][6][7][8]. Cao et al [3] and Butera [4] reported the clinical result of percutaneous closure of multiple ASDs and provided initial experience of device closure for this type of ASD.…”

“…Presenting with various morphologies, those defects are often difficult to close via transcatheter approach in technical aspect [3,5,8]. Meanwhile, due to the special design of ASD occluder device, as for two or more ASDs with close distance (<7 mm) between each other, percutaneous closure using multiple devices is also not recommended due to potential interface between the devices [3][4][5][6][7][8].…”

“…However, only limited studies have tried to examine the feasibility and effectiveness of using transcatheter closure for patients with multiple ASDs using multiple devices [3][4][5][6][7][8]. Presenting with various morphologies, those defects are often difficult to close via transcatheter approach in technical aspect [3,5,8].…”

Why, When and How Should Atrial Septal Defects Be Closed in Adults

“…A large single Amplatzer device may be deployed in the larger defect to occlude two or more smaller defects as used by and others (Roman et al 2002). While examining this technique, Szkutnik et al (2004) found that a smaller defect less than 7 mm distance from the larger defect had a 100% closure rate at 1 month follow-up. The device in the larger defect decreases the distance between the two defects or even compress the smaller defect .…”

Challenges in Atrial Septal Defect Occlusion

“…Szkutnik et al [6] reported the feasibility of this approach in 2004. A distance of less than 7 mm between defects is considered appropriate for this procedure, and a larger device should be employed to cover all the defects.…”