Feasibility of transcatheter closure in unselected patients with secundum atrial septal defect, using Amplatzer devices and a modified sizing balloon technique

Abstract

Objectives: We aimed to assess (1) the role of surgical versus transcatheter closure techniques and (2) the impact of a modified implantation technique to optimize closure of secundum septal defects with the Amplatzer device.

Background: Despite several comparative studies, the respective roles of surgical and transcatheter closure are not clarified. Additionally, the impact of modified method of implantation on device closure remains unknown.

Methods: Fifty-seven unselected patients were referred for secundum atrial septal defect closure in 2009, at a median age and weight of 27.5 (0.8-88) years and 40.6 (5.6-97) kg, respectively. Transcatheter closure was attempted in 53 cases under transesophagal echocardiography guidance in children (n = 28) and intracardiac echocardiography guidance in adults. If standard closure failed, a sizing balloon catheter inflated in the left atrium was used as a support to secure the position of the device upon deployment.

Results: Fifty of the 57 cases (88%) were successfully closed with a median Amplatzer Septal Occluder size of 20 (10-40) mm, using the sizing balloon technique in eight (16%) cases. No major complication occurred. A trivial residual shunt remained in two patients (4%) whereas a mild mitral regurgitation appeared in one. By univariate analysis, a deficient superior-posterior rim and a large defect (>15 mm(2) /m(2) ) were associated with the use of the sizing balloon technique (P = 0.04 and 0.03, respectively). A deficient superior-posterior rim and pulmonary hypertension were associated with failure to close the defect (P = 0.02 and 0.03, respectively).

Conclusion: The majority of secundum atrial septal defect is amenable to transcatheter closure, using a modified implantation technique in 16% of cases.