Percutaneous closure of interatrial communications in adults - prospective embolism prevention study with two- and three-dimensional echocardiography.
BACKGROUND
Patients with interatrial communications after paradoxical embolic events are at risk for recurrent thromboembolism. We hypothesized that transcatheter closure of the defects would result in long-term prevention of systemic embolism and performed clinical and echocardiographic follow-up.


METHODS
We included 161 patients (mean age 46.8 +/- 11 years, 83 females) with patent foramen ovale or atrial septal defect and at least one documented paradoxical systemic thrombembolic event and/or a large atrial shunting.


RESULTS
The implantation procedure was successfully performed without major complications in all patients and minor complications in 2.5%. Two and / or three dimensional echocardiography was performed before and after 4 weeks and 12 months using a multiplane transoesophageal probe. After 4 weeks and 6 months two patients had minimal shunting. These residual defects were closed with a second device implantation without shunting after further 4 weeks. During a follow-up of 324.3 patient years (range, 13 to 19 months), recurrent embolic events occurred in only 1 patient (0.6%).


CONCLUSIONS
After primary paradoxical systemic embolism, results of transcatheter occlusion of the interatrial communications are dependent on the closure device system and can prevent further secondary embolic events for up to 1 year after the percutaneous closure. Three dimensional echocardiography provides dynamic features of the defects and the post closure status and may lead to an improved understanding and diagnosis of the interatrial defect.
Knebel
Fabian
F
Medical Clinic for Cardiology, Angiology, Pulmology, Charité Campus Mitte, Berlin, Germany. fabian.knebel@charite.de
Gliech
Volker
V
Walde
Torsten
T
Panda
Alexander
A
Sanad
Wasiem
W
Eddicks
Stephan
S
Baumann
Gert
G
Borges
Adrian C
AC
D021721:Balloon Occlusion / Q000295:instrumentation / Q000379:methods*; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D004617:Embolism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome