Surgical management of complications caused by transcatheter ASD closure.
BACKGROUND
Transcatheter occlusion of uncomplicated atrial septum defects (ASD) is recognized as an effective and minimally invasive method. Sometimes, serious early and late complications require surgical intervention. We therefore investigated reasons and outcomes of the secondary surgical approach.


METHODS
5 patients (aged 5-73 yrs) were admitted to our institution for device explantation and surgical ASD closure. ASDOS devices (A devices) had to be explanted in 4 patients and a SIDERIS "buttoned" occluder (S device) had to be explanted in 1 patient. The period from transcatheter implantation to surgical explantation ranged from 1 hour to 3 years.


RESULTS
3 patients (60 %) had to be operated in an emergency setting. In our youngest patient (5 yrs), the A device separated and embolized into the aorta and pulmonary artery. A pregnant women who needed emergent cesarean section developed hemopericard and tamponade due to atrial perforation by a fractured leg of an A device. In another A device, a suspect endocarditis caused membrane perforation. Malpositioning of an S device was the reason for operation. All patients recovered well without neurological symptoms.


CONCLUSIONS
Transcatheter closure of uncomplicated ASD is a feasible alternative but surgical stand-by is essential. Nevertheless more complicated ASD should be operated, especially since the cosmetically satisfactory techniques of minimal invasive heart surgery are available.
Mellert
F
F
Department of Cardiac Surgery, Friedrich Wilhelms University, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. fritz.mellert@uni-bonn.de
Preusse
C J
CJ
Haushofer
M
M
Winkler
K
K
Nill
C
C
Pfeiffer
D
D
Redel
D
D
Lüderitz
B
B
Welz
A
A
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects*; D002675:Child, Preschool; D020878:Device Removal / Q000295:instrumentation; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D012086:Reoperation; D017211:Treatment Failure