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. 2014 Feb;4(1):21-7.
doi: 10.3978/j.issn.2223-3652.2014.02.05.

Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects

Ajith Ananthakrishna Pillai  1 , Vidhyakar Rangaswamy Balasubramanian  1 , Raja Selvaraj  1 , Maheshkumar Saktheeswaran  1 , Santhosh Satheesh  1 , Balachander Jayaraman  1
Affiliations

Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects

Ajith Ananthakrishna Pillai et al. Cardiovasc Diagn Ther. 2014 Feb.

Abstract

Background: Very few published data is available on the outcomes of balloon assisted techniques (BATs) for trans catheter closure (TCC) of very large (Defined as ≥35 mm size) ostium secundum atrial septal defect (ASD).

Objective: To study the utility of BAT as against conventional techniques (CT) in TCC of very large ostium secundum ASD (≥35 mm) over the past 5-year period and to find out the association of different morphological features of the defects in relation to TCC outcomes.

Study design and methods: Descriptive single center retrospective study of patients with very large ostium secundum ASD (≥35 mm size) who were subjected to TCC.

Results: Thirty-three out of 36 patients with ≥35 mm ASD and complex morphological features underwent successful TCC. The study patients had high prevalence of absent aortic and posterior rims with posterior mal-alignment of the septum. BAT was successful in 28/31 (90.3%) patients while CT had a success rate of 16%. The mean trans-esophageal echocardiography (TEE) ASD size with BAT success 37 (SD 1.3) mm and CT failure 36.2 (SD 1.1) mm was not different (P=0.06). On univariate analysis of different morphological features, posterior mal alignment of the septum was associated failure of CT (P=0.01). There was no urgent referral for surgery and patients did well on follow up.

Conclusions: Balloon assisted device closure of (≥35 mm) ASD had 90% success rate. BAT helps in controlled delivery and device alignment in very large ASD with posterior malalignment of the septum and is often helpful when CT fails.

Keywords: Very large atrial septal defect (very large ASD); balloon assisted technique (BAT); malaligned septum.

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Figures

Figure 1
Figure 1
Number and size distribution of septal occluders deployed with BAT and CT (total number =33). Abbreviations: BAT, balloon assisted technique; CT, conventional technique.
Figure 2
Figure 2
Serial trans esophageal images of balloon assisted device closure of 38.5 mm ASD with 42 mm ASD device. (A) Very large ASD measuring 38.5 mm with deficient posterior rim; (B) Sizing balloon occluding the defect; (C) Device in hour glass shape with either discs in respective atria and waist compressed by inflated balloon; (D) Balloon is deflated and waist expands; (E) Device in good position snuggly holding on after removal of the balloon; (F) Device after deployment. Abbreviation: ASD, atrial septal defect.
Figure 3
Figure 3
Serial fluoroscopic images of balloon assisted device closure of 38.5 mm ASD with 42 mm ASD device. (A) Left disc being delivered with balloon inflated across the defect; (B) Whole device delivered with balloon inflated, device assumes a hour glass shape with waist being compressed by the balloon; (C) The waist expands as balloon starts deflating; (D) The waist expands further as balloon gets smaller; (E) Device in good position after complete deflation; (F) Device deployed after withdrawal of the balloon. Abbreviation: ASD, atrial septal defect.
See this image and copyright information in PMC

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