Predictors of residual defects following closure of defects in the oval fossa using the Amplatzer device: echocardiography recapitulates morphometry.
OBJECTIVE
This study was designed to identify predictors of residual defects following deployment of the Amplatzer device to close septal defects within the oval fossa.


METHODS
Between February 1997 and February 2000, we used the Amplatzer device to close defects in the oval fossa in 89 patients. Of these patients, 18 (20%) had residual defects. At 6 or 12 months following placement of the device, 13 defects (14.6%) had persisted. We evaluated several variables derived from clinical features, transesophageal echocardiography and catheterization to establish predictors for residual shunting.


RESULTS
Multivariate analysis identified a shorter superior rim of less than 8 mm (Odds ratio = 10.1; 95% confidence intervals = 2.64-38.72; p = 0.001), and a smaller interatrial septum in the 30-degree transesophageal echocardiographic plane of less than 30 mm (Odds ratio = 5.5; 95% confidence intervals = 1.17-26.14; p = 0.03) as independent predictors of residual defects. When the analysis was repeated defining only those 13 patients with persisting residual defects at 6 or 12 months as failures, a short superior rim (p = 0.004) remained a predictor for residual shunting.


CONCLUSIONS
Defects with a short superior rim and smaller interatrial septum in the 30-degree transesophageal echocardiographic plane independently and additively predict an increased probability of residual shunting following closure of defects in the oval fossa using the Amplatzer device.
Balaguru
Duraisamy
D
Department of Pediatrics (Cardiology), Medical University of South Carolina, Charleston, South Carolina, USA.
Anderson
Robert H
RH
Rosenthal
Geoffrey L
GL
Cook
Andrew C
AC
Radtke
Wolfgang A K
WA
Shirali
Girish S
GS
D006328:Cardiac Catheterization; D002648:Child; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015642:Radiology, Interventional