title: Transcatheter closure of atrial septal defects with multiple devices in adults: procedural and clinical outcomes.
abstract: OBJECTIVE
  This study reports the procedural, short and medium term outcomes in patients receiving multiple implants for device closure of secundum atrial septal defects (ASD).
  
  
  METHODS
  From the database of the Toronto Congenital Cardiac Centre, 36 consecutive patients (mean age 46+/-15 years; 23 females) received >1 implant for closure of an interatrial communication. Short term (mean 97+/-77 days) and medium term (mean 2.5+/-1.4 years) follow-up data were analyzed. Procedures were performed under intracardiac echo (ICE) and fluoroscopic guidance.
  
  
  RESULTS
  The Amplatzer Septal Occluder (ASO) was implanted in all except one. Thirty-one patients had 2, and 4 patients, 3 ASO devices. There were no major adverse events at implantation or on follow-up. Patients with >NYHA class I symptoms fell from 44% to 6% (p<0.05) at 3 months. Right ventricular (RV) systolic pressure fell from 39+/-7 to 32+/-4 mm Hg in the short term (p<0.05), and to 30+/-4 mm Hg in the medium term (p<0.05, compared to baseline) and RV diameters fell from 48+/-5 to 40+/-5 (p<0.05) in the short term and to 38+/-8 mm (p=ns) in the medium term. Small residual leaks were present in 22% at 3 months and 12% (p<0.05) at 1 year.
  
  
  CONCLUSIONS
  Multiple ASD device implants can be safely employed with excellent outcomes. Significant reductions in RV pressure and diameter occur in the short term with a continued trend to benefit.
authors.affiliation: The Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, The University of Toronto School of Medicine, Canada. vaikom.mahadevan@cmmc.nhs.uk
authors.forename: Vaikom S
authors.initials: VS
authors.lastname: Mahadevan
authors.forename: Natalie
authors.initials: N
authors.lastname: Gomperts
authors.forename: Kim
authors.initials: K
authors.lastname: Haberer
authors.forename: Candice
authors.initials: C
authors.lastname: Silversides
authors.forename: Lee N
authors.initials: LN
authors.lastname: Benson
authors.forename: Peter R
authors.initials: PR
authors.lastname: McLaughlin
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horlick
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D011859:Radiography; D016896:Treatment Outcome