Percutaneous device closure for secundum-type atrial septal defect: short and intermediate-term results

ABSTRACT

Device closure of an isolated secundum type atrial septal defect [ASD] has been used as an alternative method for open surgical closure with comparable success and lower morbidity. In this study we evaluated the procedural success and mid-term follow-up results of percutaneous closure of secundum ASD with an Amplatzer TM Septal Occluder [ASO] device or a Figula ASD occluder device. From June 2001 to January 2009, 74 consecutive patients were scheduled for percutaneous device closure in two centers in Tehran, Iran. All patients had a stretched defect diameter of 30mm or less. After using a sizing balloon to measure the stop-flow diameter, device implantation was performed under the guidance of a trans-esophageal echocardiography [TEE].The size was generally 1 - 2 mm larger than the stretched diameter. Patients were followed for an average of 11 +/- 4 months. The median stretched diameter of the defect was 20.7 +/- 4.8 mm [range 8 - 30 mm].A total of 73 devices were used in this study. Device closure was successful in 72 [97.2%] out of 74 patients. Repositioning of the device was required in one patient. Major complications [including significant residual shunt and device embolization] occurred in 3 [4%] patients. There was no procedure-related mortality in our patients. Mild-to-moderate residual shunt was detectable in 10 [13.7%] patients immediately following the procedure and in 5 [6.7%] patients 24 hours after the procedure. None had residual flow across the device at the end of the follow-up period. Device closure of ASD has a safety profile comparable to open surgical repair and can effectively close the defect with excellent procedural and mid-term results: