[Transcatheter closure of atrial septal defects in adults. Practicality and safety of four different closure systems used in 102 patients].
OBJECTIVE
Surgical closure of secundum atrial septal defect (ASD) or patent foramen ovale (PFO) is a procedure with few complications. But this surgical intervention can nowadays be avoided by transcatheter insertion of occluding devices. Such interventional methods must be judged against the results of surgical procedures. This report from one center presents the practicability and safety of different transcatheter occluder systems.


METHODS
Transcatheter occlusion was undertaken in 102 patients (40 females, 62 males, aged between 17 and 76 years [median age 45]) with either an ASD (41pts.) or a PFO (60 pts.) or with both, in one patient. Four different systems were used: ASDOS (for ASD and PFO), PFO-STAR (for PFO), Amplatzer Septal Occluder (for ASD) or Amplatzer PFO Occluder (for PFO). Follow-up, including transoesophageal echocardiography took place 48 hours, 4 weeks, 6 months and 1 year after the interventional occluder placement.


RESULTS
An occluder was successfully placed in the ASD or PFO in 99 of the 102 patients. In three patients the occluder ( ASDOS ASD) could not be correctly ancchored in the defect. In two other patients the same device was subsequently removed surgically because of mispositioning or a large resiudal shunt. Occluder-associated problems were: mild (41%) or extensive (11%) thrombus formation on the occluder without early embolization, residual shunt at one year (ASD 16%, PFO 29%); minor displacement (10%) or broken umbrella strut (6%) of no clinical relevance. One patient required emergency surgical intervention on the day of the transcatheter placement (PFO-STAR) because of pricardial tamponade. Primary complete occlusion was achieved in 71%. There was no case of cerebral emboli.


CONCLUSIONS
Transcatheter occlusion of ASD and/or PFO is a reliable and safe procedure. Regarding peri- and/or postinterventional complications, primary results and practicability, the Amplatzer septal occluder and Amplatzer PFO occluder are particularly advantageous.
La Rosée
K
K
Klinik III für Innere Medizin (Direktor: Prof. Dr. E. Erdmann), Universität Köln. Karl.LaRosee@Uni-Koeln.de
Krause
D
D
Becker
M
M
Beuckelmann
D J
DJ
Deutsch
H J
HJ
Höpp
H W
HW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D019736:Prostheses and Implants; D012449:Safety; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome
D000925:Anticoagulants