Percutaneous closure of multiple defects of the atrial septum: procedural results and long-term follow-up.
BACKGROUND
The percutaneous closure of single atrial septal defect (ASD) is a valid alternative to surgery.


OBJECTIVE
To assess the feasibility of percutaneous treatment of multiple ASDs.


METHODS
Between 1998 and 2007, 165 out of 1280 consecutive patients undergoing ASD percutaneous closure at our institution showed multiple defects that were classified in four categories: double atrial septal defects (d-ASD), multifenestrated atrial septal defects (f-ASD), multifenestrated defects with no signs of right heart overload (f-PFO), and complex cases (c-ASD). The following end points were taken into consideration: (1) immediate procedural success; (2) long term safety and efficacy. In this study, up to 81% of multiple ASDs were suitable for percutaneous closure.


RESULTS
Multiple device implantations were required in 47% of cases, especially in patients with d-ASD and c-ASD. Complication rate, residual shunt, and long term outcome were comparable among the four different categories. In particular, at long term follow-up (6 +/- 2 years) no patient required further surgical or percutaneous treatment and complete closure was confirmed in 99% of cases.


CONCLUSIONS
Percutaneous closure of multiple ASDs is feasible and associated with a good outcome. A thorough identification and analysis of morphological aspects are mandatory in order to select the appropriate device and the optimal strategy.
Butera
Gianfranco
G
Pediatric Cardiology and GUCH unit, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese (MI), Italy. gianfra.but@lycos.com
Romagnoli
Enrico
E
Saliba
Zakhia
Z
Chessa
Massimo
M
Sangiorgi
Giuseppe
G
Giamberti
Alessandro
A
Cappato
Riccardo
R
Bussadori
Claudio
C
Abella
Raul
R
Pelissero
Gabriele
G
Frigiola
Alessandro
A
Carminati
Mario
M
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult