Long-term follow up of secundum atrial septal defect closure with the amplatzer septal occluder.
BACKGROUND
During the past 15 years, closure of a secundum atrial septal defect (ASD) has moved from a surgical to a percutaneous transcatheter approach. Few long-term studies of the efficacy and safety of closure of an ASD by an Amplatzer septal occluder (ASO) exist.


METHODS
To examine the long-term results of secundum ASD closure using the ASO, data on 94 patients who underwent secundum ASD closure with the ASO between 1998 and 2002 were available and reviewed. Data regarding residual shunt, chest pain, palpitations, arrhythmias, headaches, transient ischemic attacks, cerebrovascular accidents, and mortality were collected.


RESULTS
Seven (7.4%) subjects had residual shunts immediately following ASO placement. During follow-up, 4 residual shunts closed for a complete closure rate of 97%. Eighteen (19%) patients reported chest pain during the follow-up period. Twenty-three patients (24%) reported palpitations during the follow up period, 7 were documented arrhythmias, including supraventricular tachycardia, atrial fibrillation, and premature ventricular beats. Migraine headaches were new-onset in 4 patients. Migraine cessation occurred in 2 patients after secundum ASD closure. One child died from a cerebral vascular event 18 months following device placement. Only 1 patient developed mild aortic insufficiency.


CONCLUSIONS
These data indicate that for up to 120 months of patient follow-up, the ASO continues to be a safe device. Residual shunts and arrhythmias have low incidence post-ASO placement. Given the mortality in one high-risk patient, further investigation into anti-platelet therapy after device placement is warranted.
University of Michigan Congenital Heart Center-Department of Pediatrics, Ann Arbor, MI 48109, USA. mknepp@umich.edu
Marc D
MD
Knepp
Albert P
AP
Rocchini
Thomas R
TR
Lloyd
Ranjit M
RM
Aiyagari
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002637:Chest Pain / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D006261:Headache / Q000209:etiology; D006344:Heart Septal Defects, Atrial / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D055989:Septal Occluder Device; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome