title: Transcatheter closure of secundum atrial septal defects with complex anatomy.
abstract: The aim of this study was to evaluate the feasibility, safety and efficacy of transcatheter closure of secundum atrial septal defects (ASD) in patients with complex anatomy. From September 1997 to July 2003, a total of 40 patients (median age, 34 years; 65% female) with complex ASDs, defined as the presence of a large defect (stretched diameter >26 mm) associated with a deficient rim (n=23); multiple defects (n=8); a multi-fenestrated septum (n=5); and defects associated with an aneurysmal septum irrespective of their size (n=4) underwent closure. The Helex device was used in 4 patients and the Amplatzer in the remaining. Two devices were implanted in 2 patients each. Implantation was unsuccessful in 5 patients, with 4 having large defects associated with a deficient anterior rim and a floppy posterior septum. Occlusion was observed in 22 of 35 patients (63%) immediately after implantation and in 31 (89%) at a mean follow-up of 18+/-9 months. No major complications occurred. Right ventricular end-diastolic dimensions (indexed for body surface area) decreased from 135+/-25% before closure to 124+/-15% 24 hours after closure, and to 92+/-12% after 12 months. Two patients with 2 distant defects and 2 patients with large defects remained with shunts (<4 mm) at the latest visit. Transcatheter closure of complex secundum ASDs was feasible, safe and effective; however, large defects associated with a deficient anterior rim and a floppy posterior septum may not be suitable for this approach.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, Av Dr Dante Pazzanese 500, CEP 04012-180, Sao Paulo, SP, Brazil. cacpedra@uol.com
authors.forename: Carlos A C
authors.initials: CA
authors.lastname: Pedra
authors.forename: Simone R F
authors.initials: SR
authors.lastname: Pedra
authors.forename: César A
authors.initials: CA
authors.lastname: Esteves
authors.forename: Renata
authors.initials: R
authors.lastname: Cassar
authors.forename: Sérgio C
authors.initials: SC
authors.lastname: Pontes
authors.forename: Sérgio L N
authors.initials: SL
authors.lastname: Braga
authors.forename: Valmir F
authors.initials: VF
authors.lastname: Fontes
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000295:instrumentation*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods; D002648:Child; D003287:Contrast Media; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012449:Safety; D013525:Surgical Instruments
chemical_list: D003287:Contrast Media