Outcomes and alternative techniques for device closure of the large secundum atrial septal defect.
Outcomes of device closure of large and small secundum atrial septal defects (ASDs) as related to rim anatomy with the Amplatzer atrial septal occluder were compared. Rim adequacy (> or = 5mm) of the anterior, inferior, posterior, and superior rims was determined using transesophageal echocardiography. Balloon-stretched defect size defined patients into two groups: group 1, < or = 25 mm (n = 138); group 2, > 25 mm (n = 34). Rim deficiency (n = 62) was more frequent in group 2 compared to group 1 (50% vs. 33%; P = 0.07), especially inferior rim deficiency (35% vs. 2%; P = 0.005). Device deployment was successful in group 1 and group 2 (100% vs. 91%; P = 0.007). Unsuccessful deployment was associated with an ASD of > 25 mm (P = 0.007) and inferior rim deficiency (P = 0.001). At first follow-up (54 +/- 16 days), right ventricular systolic pressure had improved in both groups (P < 0.001). Closure of a large ASD associated with a lack of support in the inferior rim may warrant alternative strategies to position the device successfully.
Varma
Chetan
C
University of Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Ontario, Canada.
Benson
Lee N
LN
Silversides
Candice
C
Yip
J
J
Warr
Matthew R
MR
Webb
Gary
G
Siu
Samuel C
SC
McLaughlin
Peter R
PR
D000328:Adult; D001837:Body Weights and Measures; D006328:Cardiac Catheterization / Q000379:methods; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome