Early and late complications associated with transcatheter occlusion of secundum atrial septal defect.
OBJECTIVE
The goal of this study was to report the early and late complications experienced in atrial septal defect (ASD) transcatheter closure.


BACKGROUND
Atrial septal defect transcatheter occlusion techniques have become an alternative to surgical procedures. A number of different devices are available for transcatheter ASD closure. The type and rate of complications are different for different devices.


METHODS
Between December 1996 and January 2001, 417 patients (mean age: 26.6 +/- 19 years) underwent transcatheter occlusion of secundum type ASD. Complications were categorized into major and minor. Two different devices were used: the CardioSEAL/STARFlex in 159 patients and the Amplatzer septal occluder in 258 patients.


RESULTS
Thirty-four patients experienced 36 complications during the hospitalization (8.6%, 95% confidence interval: 6.1% to 11.1%). Ten patients underwent elective surgical repair because of device malposition (three patients) or device embolization (seven patients). Twenty-four patients experienced 25 minor complications: unsatisfactory device position or embolization. Devices were retrieved using a gooseneck snare and/or a basket; 11 patients experienced arrhythmic problems. Other complications were: pericardial effusion, thrombus formation on the left atrial disc, right iliac vein dissection, groin hematoma, hemorrhage in the retropharynx and sizing balloon rupture. Two patients had late complications: peripheral embolization in the left leg one year after implantation of an Amplatzer device and sudden death 1.5 year later.


CONCLUSIONS
Our series of patients with ASD by transcatheter occlusion shows that the procedure is safe and effective in the vast majority of cases. To further reduce the complications rate, the criteria of device selection according to ASD morphology and some technical tips during implantation are discussed.
Chessa
Massimo
M
Pediatric Cardiology, Istituto Policlinico San Donato, San Donato Milanese, Italy. massimo.chessa@lycos.com
Carminati
Mario
M
Butera
Gianfranco
G
Bini
Roberta Margherita
RM
Drago
Manuela
M
Rosti
Luca
L
Giamberti
Alessandro
A
Pomè
Giuseppe
G
Bossone
Eduardo
E
Frigiola
Alessandro
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004452:Echocardiography; D004562:Electrocardiography; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005548:Foreign-Body Migration; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D012086:Reoperation; D013997:Time Factors; D017211:Treatment Failure
D000925:Anticoagulants