Non surgical closure of atrial septal defect using the Amplatzer septal occluder in children--feasibility and early results.

ABSTRACT

OBJECTIVE: To assess the feasibility and early results of Amplatzer septal occluder in children withy secundim atrial septal defect. SETTING: Tertiary care referral hospital in New Delhi. METHODS: Forty nine children under 12 years of age were diagnosed to be having fossa ovalis atrial septal defect. Forty nine patients underwent detailed 2D-Echocardiography and color Doppler interrogation for the possibility of non-surgical closure of ASD. Sixteen children between age 2.5-12 years (mean 6.5 years) were enrolled into the study. Their weight ranged from 10 kg to 42 kg and there were 9 males and 7 females. The remaining 33 were not considered suitable for device closure in echocardiography and were referred for surgery. RESULTS: All patients had more than 1.8 1 shunt. The device was successfully deployed in 13/16 patients. ASD stretched diameter ranged between 13 mm-30 mm (mean 15 mm) and the device size ranged between 14 mm-22 mm. One patient had fenestrated ASD, in this patient the largest of the defect was crossed and closed with 24 mm device resulting in closure of all three defects. We failed in three of our attempts, on one there were deficient inferior margins while in the other two cases the ASD stretched size was such that the device would have encroached upon adjacent structures, hence the procedure was abandoned. All these patients have been operated successfully. Complete abolition of shunt was seen in 38% patients in the immediate post deployment period. At 24 hours complete closure was seen in 12/13 (92%) patients while one patient had trivial residual shunting across the device. This patient also achieved complete closure of atrial shunting when evaluated at three months follow-up. CONCLUSION: Device closure of ASD is emerging as an alternative to surgical closure. However, with the currently available device only a limited number of atrial septal defects can be closed. Long-term studies are required to show sustained benefits and absence of side effects of this device.