title: Percutaneous closure with Amplatzer device is a safe and efficient alternative to surgery in adults with large atrial septal defects.
abstract: BACKGROUND
  In adults with atrial septal defect (ASD) and large right-to-left shunt, closure of the defect is recommended. Percutaneous closure is still rarely used in this population. This study presents the results of transcatheter closure with the Amplatzer occluder in such patients.
  
  
  RESULTS
  We studied 44 consecutive adult patients with a secundum ASD and 2 of the 3 following criteria: QP/QS >/=2 by oximetry, echocardiographic right ventricle overload, and ASD size >20 mm. Forty-two patients had a successful implantation. In 1 patient an unstable device was withdrawn; in another one, the device embolized in the pulmonary artery. At 6-month median follow-up, 95% had a complete closure; 2 patients with an additional defect had a small residual shunt. Major complications were the aforementioned embolization and a cerebrovascular accident in a patient with atrial fibrillation treated with aspirin. Others were minor and transitory: premature atrial beats in 3 patients, and paroxysmal atrial fibrillation and pulmonary edema in 1 patient each.
  
  
  CONCLUSIONS
  Transcatheter closure of large ASDs with the Amplatzer device is efficient with less morbidity than surgical closure.
authors.affiliation: Hôpital Marie Lannelongue, Université Paris-Sud., Le Plessis Robinson, France. jlosay@ccml.com
authors.forename: J
authors.initials: J
authors.lastname: Losay
authors.forename: J
authors.initials: J
authors.lastname: Petit
authors.forename: V
authors.initials: V
authors.lastname: Lambert
authors.forename: G
authors.initials: G
authors.lastname: Esna
authors.forename: X
authors.initials: X
authors.lastname: Berthaux
authors.forename: P
authors.initials: P
authors.lastname: Brenot
authors.forename: C
authors.initials: C
authors.lastname: Angel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications