title: Effect of atrial septal mobility on transcatheter closure of interatrial communications.
abstract: BACKGROUND
  Transcatheter techniques have evolved as alternatives to surgical closure of interatrial communications due to its less invasive nature and low morbidity. The technique may be limited by the inability to deploy the device and, thus, may be complicated by significant residual shunting. Mobile or redundant septal tissue has been implicated as a possible cause of unsuccessful closure.
  
  
  METHODS
  To determine if atrial septal hypermobility precludes successful transcatheter device closure of interatrial communications, 69 patients (mean age 46.4 +/- 17.5 years [male:female ratio 34:35]) with periprocedural transesophageal echocardiograms were reviewed. Septal excursion was defined as the maximal transit of the interatrial septum between either side of the plane connecting the superior and inferior attachment points. Unsuccessful closure was defined as subsequent cardiac surgery to close the defect, inability to deploy the device, recurrent attempts at closure, device malalignment, residual shunting greater than mild in degree on follow-up transthoracic study, and procedural complications.
  
  
  RESULTS
  Reasons for closure were the following: embolic events (n = 48); platypnea/orthodeoxia (n = 15); atrial septal defect with right ventricular dilatation and paroxysmal atrial tachycardia (n = 2); atrial septal defect (n = 3); and prophylactic patent foramen ovale closure in a scuba diver (n = 1). Successful closure occurred in 76% of patients (n = 53). Compared with those patients with successful transcatheter closure, the mean septal excursion in patients with failed closure was 0.66 +/- 0.56 cm versus 0.76 +/- 0.47 cm (P = not significant [NS]).
  
  
  CONCLUSIONS
  Our results do not support the concern that exaggerated septal mobility compromises successful device closure of interatrial communications.
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Nandita S
authors.initials: NS
authors.lastname: Scott
authors.forename: Mary Etta
authors.initials: ME
authors.lastname: King
authors.forename: Brendan
authors.initials: B
authors.lastname: McQuillan
authors.forename: Salima
authors.initials: S
authors.lastname: Shariff
authors.forename: Judy W
authors.initials: JW
authors.lastname: Hung
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000379:methods*; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome