title: Atrial septal closure in adults: surgery versus amplatzer--comparison of results.
abstract: OBJECTIVE
  To compare the efficacy, safety and morbidity of surgical versus percutaneous atrial septal defect (ASD) closure.
  
  
  METHODS
  We studied all cases of ASD closure (surgical or percutaneous) performed in our hospital during the last 5 years. We analyzed the clinical and echocardiographic characteristics of both groups and compared the success rate of the procedure, events, days of hospital stay and evolution during the 1st year.
  
  
  RESULTS
  63 patients (pts) with ostium secundum ASD were treated in our hospital in the last 5 years; 25 (60% female) underwent surgery (A) while 38 (68% female) underwent percutaneous closure with an Amplatzer device (B); mean age was 38 (13-67) and 40 years (15-72), respectively. Dyspnea and fatigue were the most frequent symptoms in both groups (57% A; 29% B), while the most frequent signs were fixed splitting of S2 (78% A; 88% B) and systolic murmur at the left sternal border (82% A; 87% B). Previous ECG presented incomplete right bundle branch block in 63% of both groups. The size of the ASDs, as well as Qp:Qs, were greater in the surgical group: 24.6 (5-50) vs. 18.97 mm and 3.1 (1.5-6.5) vs. 2.7 (1.2-5.2) respectively. Right cardiac chambers were enlarged in 92% of pts in A vs. 84% in B. Paradoxical interventricular septal motion (PSM) was present in 78% of pts in A and 67% in B. The success rate (100%) was similar in both groups but immediate minor events were more frequent in A (28 vs. 13%). Duration of hospital stay was longer in A: 5.4 days (3-9) vs. 1.5 days (1-4). Normalization of right cardiac chamber diameter was faster in B: 73% in the 1st control echocardiogram (at 0-64 days, mean 29) vs. 60% in A, performed at a later stage (45-455 days after the procedure, mean 155). At the time of reassessment PSM was still present in all the pts of group A and in only 10% of B (p < 0.0001).
  
  
  CONCLUSIONS
  The success rate of ASD closure is 100% with both procedures and complications are rare. The percutaneous technique, however, permits a shorter hospital stay, involves less morbidity, and, despite sample limitations, seems to be associated with faster anatomical recovery. Therefore, in our opinion, surgical treatment should be reserved for those cases in which closure with an Amplatzer device is not technically or anatomically possible.
authors.affiliation: Serviço de Cardiologia, Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia. nunobett@netcabo.pt
authors.forename: Nuno
authors.initials: N
authors.lastname: Bettencourt
authors.forename: Nuno
authors.initials: N
authors.lastname: Salomé
authors.forename: Filipe
authors.initials: F
authors.lastname: Carneiro
authors.forename: Manuel
authors.initials: M
authors.lastname: Gonçalves
authors.forename: José
authors.initials: J
authors.lastname: Ribeiro
authors.forename: José Pedro
authors.initials: JP
authors.lastname: Braga
authors.forename: Conceição
authors.initials: C
authors.lastname: Fonseca
authors.forename: Duarte M
authors.initials: DM
authors.lastname: Correia
authors.forename: Luís
authors.initials: L
authors.lastname: Vouga
authors.forename: Vasco Gama
authors.initials: VG
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012189:Retrospective Studies