title: Feasibility of transcatheter closure in unselected patients with secundum atrial septal defect, using Amplatzer devices and a modified sizing balloon technique.
abstract: OBJECTIVE
  We aimed to assess (1) the role of surgical versus transcatheter closure techniques and (2) the impact of a modified implantation technique to optimize closure of secundum septal defects with the Amplatzer device.
  
  
  BACKGROUND
  Despite several comparative studies, the respective roles of surgical and transcatheter closure are not clarified. Additionally, the impact of modified method of implantation on device closure remains unknown.
  
  
  METHODS
  Fifty-seven unselected patients were referred for secundum atrial septal defect closure in 2009, at a median age and weight of 27.5 (0.8-88) years and 40.6 (5.6-97) kg, respectively. Transcatheter closure was attempted in 53 cases under transesophagal echocardiography guidance in children (n = 28) and intracardiac echocardiography guidance in adults. If standard closure failed, a sizing balloon catheter inflated in the left atrium was used as a support to secure the position of the device upon deployment.
  
  
  RESULTS
  Fifty of the 57 cases (88%) were successfully closed with a median Amplatzer Septal Occluder size of 20 (10-40) mm, using the sizing balloon technique in eight (16%) cases. No major complication occurred. A trivial residual shunt remained in two patients (4%) whereas a mild mitral regurgitation appeared in one. By univariate analysis, a deficient superior-posterior rim and a large defect (>15 mm(2) /m(2) ) were associated with the use of the sizing balloon technique (P = 0.04 and 0.03, respectively). A deficient superior-posterior rim and pulmonary hypertension were associated with failure to close the defect (P = 0.02 and 0.03, respectively).
  
  
  CONCLUSIONS
  The majority of secundum atrial septal defect is amenable to transcatheter closure, using a modified implantation technique in 16% of cases.
authors.affiliation: Cardiologie pédiatrique et congénitale, hôpital de Timone-Enfants, 264 rue St Pierre, 13005 Marseille, France.
authors.forename: Issam
authors.initials: I
authors.lastname: Kammache
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Caroline
authors.initials: C
authors.lastname: Ovaert
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.forename: Alain
authors.initials: A
authors.lastname: Fraisse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005602:France; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055989:Septal Occluder Device; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult