title: Clinical results of percutaneous closure of large secundum atrial septal defects in children using the Amplatzer septal occluder.
abstract: We reviewed our experience using the Amplatzer septal occluder (AGA Medical, Golden Valley, MN, USA) to close large, secundum-type atrial septal defects (ASDs) in children. Between June 2002 and December 2005, 52 patients (mean age 13.5 +/- 8.7 years) underwent transcatheter closure of large (> or =25 mm), secundum ASDs with the use of the Amplatzer septal occluder (ASO). Groups 1 and 2 included patients with a retroaortic rim of <5 mm (n = 39) or > or =5 mm (n = 13), respectively. All procedures were performed with general anesthesia and transesophageal echocardiographic guidance except for 10 patients, which involved local anesthesia and three-dimensional transthoracic echocardiography. Successful device implantations, device sizes, approaches, complications, and closure rates were assessed. Device implantation was successful in 50 patients (96.1%), with no difference between groups (95% vs 100%, P>0.05). In 2 patients, implantation failed because of embolism or deployment failure. Device were larger in group 1 than in group 2 (29.7 +/- 4.2 vs 26.7 +/- 3.8 mm, P = 0.04). The right upper pulmonary-vein approach was more common in group 1 than in group 2 (P = 0.0001). Complications and closure rates did not differ between the groups (P > 0.05). Transcatheter closure of large, secundum ASD by using the ASO device was feasible, and complication rates were low. A deficient retroaortic rim did not preclude successful device implantation; however, a large device may be needed to close large ASD. Close long-term follow-up is necessary to determine the safety of transcatheter closure of large ASDs in children.
authors.affiliation: Department of Pediatric Cardiology, Veterans General Hospital Kaohsiung, National Sun Yat-sen University, Institute of Biomedical Sciences, 386 Ta-Chung 1st Rd., Kaohsiung, 813, Taiwan, China. tchuang@isca.vghks.gov.tw
authors.forename: Ta Cheng
authors.initials: TC
authors.lastname: Huang
authors.forename: Kai-Sheng
authors.initials: KS
authors.lastname: Hsieh
authors.forename: Chu-Chun
authors.initials: CC
authors.lastname: Lin
authors.forename: Cheng-Liang
authors.initials: CL
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D021721:Balloon Occlusion / Q000009:adverse effects / Q000295:instrumentation*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult