[Early haemodynamic changes after transcatheter closure of atrial septal defect].
OBJECTIVE
To evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) using the Amplatzer Septal Occluder (ASO).


METHODS
Between December 2000 and December 2002, 27 adult patients (20 females, 7 males) with a mean age of 41.1 +/- 13.3 (range 18-62) years were enrolled for an attempt at ASD closure with the ASO device. All patients had an isolated secundum ASD with a large left-to-right shunt (ratio of pulmonary to systemic blood flow or Qp:Qs >1.5:1). Transthoracic color Doppler echocardiographic examination was performed on all patients before procedure, 24 hours, 1 and 6 months after surgery. Clinical observation (NYHA class) was performed 1 and 6 months after surgery.


RESULTS
The ASO device was successfully implanted in all patients (procedure time 19-63 minutes, median 43 minutes, fluoroscopy time 4-40 minutes, median 12.6 minutes), with only 3 patients with a trivial residual shunt. The defect echo diameter was 14.2 +/- 4.3 (7-24). At one month of follow-up transthoracic echocardiography showed that the device was correctly positioned in all cases and no predictors for a residual shunt were identified. Residual trivial shunt in one month follow-up was shaded in 3 patients. Paradoxical septal motion abnormalities normalized in all patients. The right ventricular dimension evaluated by 2D echocardiography decreased in 20 pts (74.1%), mean 5.0 +/- 3.4 mm (range 1.5-8), the right atrium dimension decreased in 21 pts (77.8%), mean 8.65 +/- 4.3 mm (range 2-20) and the left atrium dimension decreased in 15 pts (55.6%), mean 6.36 +/- 3 mm (range 2-21). We didn't find correlations between ratio of left-to-right shunt before ASD closure and the decrease of right heart dimension as well as the decrease of pulmonary artery systolic pressure.


CONCLUSIONS
Transcatheter closure of secundum ASD using the ASO is a safe and effective procedure, with excellent short-term follow-up results. During one month observation it caused partial normalization of echocardiographic parameters.
Podolec
Piotr
P
Klinika Chorób Serca i Naczyń, Instytutu Kardiologii Collegium Medicum, Uniwersytetu Jagiellońskiego, Kraków.
Przewłocki
Tadeusz
T
Pieculewicz
Monika
M
Hlawaty
Marta
M
Tomkiewicz-Pajak
Lidia
L
Płazak
Wojciech
W
Wilkołek
Piotr
P
Zmudka
Krzysztof
K
Tracz
Wiesława
W
D000328:Adult; D021721:Balloon Occlusion / Q000295:instrumentation* / Q000379:methods; D006328:Cardiac Catheterization; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016896:Treatment Outcome