Transcatheter closure of atrial septal defects by amplatzerTM septal occluder instead of open heart surgery.

ABSTRACT

Although surgical repair of secundum atrial septal defect (ASD) is a safe, widely accepted procedure with negligible mortality, it is associated with morbidity, discomfort and a thoracotomy scar. As an alternative to surgery, a variety of devices for transcatheter closure of ASD have been developed. Large delivery sheath, difficult implantation technique, inability to capture, and structural failure are some of the limitations of previous devices. Objective: This study reports our clinical experience with transcatheter closure of ASD using the AmplatzerTM Septal Occluder , a new occlusion device. Methods: Patients with ASD met established two-dimensional echocardiographic criteria for transcatheter closure. ASD size was measured by transesophageal echocardiogram (TEE) and balloon occlusion catheter (stretched diameter). The AmplatzerTM ’s size was chosen to be equal to stretched dia-meter (+ 1 mm). The device was advanced transvenously into a guiding sheath and deployed under fluoroscopic and TEE guidance. Once its position was optimal, it was released. Right atrial atriogram and TEE were undertaken to demonstrate the residual shunt. Results: There were 5 patients with mean age of 9.6+8.4 years and mean weight of 24.7 + 14.9 kg. The mean ASD diameter measured by TEE was 16.1+ 2 mm and by stretched diameter was 18.5 + 3.5 mm. The mean device diameter was 19.2 + 4 mm (range 15 to 24 mm). Immediately after the deployment, a tiny residual shunt was observed at the core of the device in each case. However, at 24 hours only one patient who had a 24 mm device placed had a small (<2 mm) residual shunt. No complication was encountered during the procedure. Conclusion: The AmplatzerTM Septal Occluder is a prosthesis that can be easily deployed in patients with secundum ASD. The result of closure was excellent. This device could be used to close large ASD (particularly with diameter > 20 mm) safely in our patients.