title: Outcomes and alternative techniques for device closure of the large secundum atrial septal defect.
abstract: 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.
authors.affiliation: University of Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Chetan
authors.initials: C
authors.lastname: Varma
authors.forename: Lee N
authors.initials: LN
authors.lastname: Benson
authors.forename: Candice
authors.initials: C
authors.lastname: Silversides
authors.forename: J
authors.initials: J
authors.lastname: Yip
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Warr
authors.forename: Gary
authors.initials: G
authors.lastname: Webb
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Siu
authors.forename: Peter R
authors.initials: PR
authors.lastname: McLaughlin
mesh_terms: 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