title: Percutaneous closure of atrial septal defects: a decade of experience at a reference center.
abstract: BACKGROUND
  Atrial septal defects (ASD) are among the most common congenital anomalies and account for 10% of congenital heart disease in the pediatric age-group and 30% in adults. Closure is indicated when there is evidence of hemodynamic significance or after a paradoxical embolic event. Ten years ago, percutaneous closure became the treatment of choice in our center for all patients with a clear indication and favorable anatomy. In this paper we report the experience of this first decade.
  
  
  OBJECTIVE
  To assess the short- and long-term results of our ten-year experience with percutaneous closure of atrial septal defects.
  
  
  METHODS
  We studied retrospectively all patients with ASD treated with a percutaneous approach between November 1998 and December 2008. The pediatric age-group consisted of patients younger than 19 years old. Demographic data, clinical indications, minor and major complication rates, success rate and long-term outcome were assessed.
  
  
  RESULTS
  In the first ten years of experience 510 patients, of whom 166 were in the pediatric group, were treated in our center by a team of adult and pediatric cardiologists. The overall success rate of the procedure was 98% (97.5% in ASD and 99.5% in patent foramen ovale (PFO). The minor complication rate was 3% (3.4% in ASD and 2% in PFO). The most frequent complication was supraventricular tachycardia. The major complication rate was 1.2% (0.6% in ASD and 2% in PFO). Two patients developed cardiac tamponade due to hemopericardium that was resolved by pericardiocentesis, without need for surgery. One patient had an arterial pseudoaneurysm corrected by vascular surgery. There was no device embolization and no need for urgent surgery in this population. During follow-up two patients had recurrence of ischemic stroke, one had a transient ischemic attack and another had a hemorrhagic stroke. Mortality was 0.6% (0.6% in ASD and 0.5% in PFO). There were no in-hospital deaths. During follow-up there were two deaths, both in the adult group.
  
  
  CONCLUSIONS
  In this population the success rate was high and most of the complications were minor. The results of this collaboration between adult and pediatric cardiologists in the first ten years of activity confirm the safety and efficacy of percutaneous closure of septal defects, when there is careful patient selection and a standardized technique.
authors.affiliation: Serviço de Cardiologia do Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal. a.fiarresga@gmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Fiarresga
authors.forename: Lídia
authors.initials: L
authors.lastname: De Sousa
authors.forename: José Dioco
authors.initials: JD
authors.lastname: Martins
authors.forename: Ruben
authors.initials: R
authors.lastname: Ramos
authors.forename: Filipa
authors.initials: F
authors.lastname: Paramés
authors.forename: Isabel
authors.initials: I
authors.lastname: Freitas
authors.forename: José Alberto
authors.initials: JA
authors.lastname: Oliveira
authors.forename: Conceiçãao
authors.initials: C
authors.lastname: Trigo
authors.forename: Ana
authors.initials: A
authors.lastname: Agapito
authors.forename: Rui Cruz
authors.initials: RC
authors.lastname: Ferreira
authors.forename: Fátima
authors.initials: F
authors.lastname: Pinto
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D055989:Septal Occluder Device; D013997:Time Factors