Transcatheter Closure of Multiple Defects of the Atrial Septum: Technique and Follow-Up

Abstract

Introduction: Although multiple defects of the atrial septum are not uncommon, there remain limited data regarding the use of multiple devices in these patients. A variety of approaches to transcatheter closure have been used, and in this paper we describe the experience from two operators in a single centre. Methods: From September 2002 to September 2012, 673 transcatheter atrial septal defects (ASD) and patent foramen ovale (PFO) closure procedures were performed and retrospectively examined in a registry analysis. Results: Of these, 22 patients had multiple discrete defects, and four different approaches to closure were used. In 4 patients (18.2%) one device was used percutaneously to close multiple defects. Eleven patients (50%) had two devices inserted during the same procedure while two patients (9%) had two devices inserted as staged procedures. One patient (4.5%) had three devices inserted over two procedures. Four patients (18.2%) were found not to be suitable for percutaneous closure during the procedure and were referred for surgical closure. Conclusion: Our experience with the implant procedures, and clinical follow up of patients, shows that patients with multiple defects can be effectively treated with transcatheter device techniques including single device closure, multiple devices in one procedure and multiple devices in staged procedures and also with surgical repair.

New solution for old challenge: device closure of non-centrally positioned atrial septal defect

“…Therefore, there are different approaches to percutaneous closure. 4 , 8 There are some unsuccessful reports about percutaneous approach and surgical refer of these patients due to the considerable residual shunt after device closure. 4 , 8 …”

“… 1 , 3 In cases like this, the attempt at crossing the true defect might totally fail or might be difficult because the wire or catheter crosses the central defect repeatedly despite the use of a sizing balloon. 4 - 6 …”

“…Patients with multiple defects can be effectively treated with Transcatheter techniques, including single device closure, multiple devices in one procedure and multiple devices in staged procedures, and with surgical repair. 4 , 5 The problem arises when a centrally located defect or a patent foramen oval (PFO) is associated with another defect that is located peripherally.…”

Percutaneous closure of atrial septal defect: a consensus document of the joint group of experts from the Association of Cardiovascular Interventions and the Grown-Up Congenital Heart Disease Section of the Polish Cardiac Society

“…This ensures the least bulky profile of the atrial septum. 60 Alternatively, occluders can be implanted sequentially, but there is no agreement on this topic in the available literature on which occluder should be implanted first: larger or smaller. [59][60][61] may precipitate acute LV insufficiency.…”

“…60 Alternatively, occluders can be implanted sequentially, but there is no agreement on this topic in the available literature on which occluder should be implanted first: larger or smaller. [59][60][61] may precipitate acute LV insufficiency. For this reason, the balloon occlusion test (balloon inflation sealing the defect until the shunt completely disappears, lasting 10-15 minutes along with PCWP and PAP monitoring) should be performed.…”