title: Transcatheter closure of large atrial septal defects with deficient aortic or posterior rims using the "Greek maneuver". A multicenter study.
abstract: OBJECTIVE
  We report a modification ("Greek maneuver") of the standard atrial septal defect (ASD) closure technique using the Amplatzer septal occluder (ASO) to facilitate closure of large ASDs with deficient aortic or posterior rims.
  
  
  METHODS
  185 patients (median 10.8, range 3 to 52 years) with large ASDs (mean diameter 26±7 mm, range 20-40 mm) with a deficient aortic (134 patients) or posterior (51 patients) rim underwent catheter closure with the ASO using the "Greek maneuver" under transesophageal guidance. The Greek maneuver is applied when protrusion of the aortic edge of the deployed left disk of the device in to the right atrium is detected by echo. To circumvent this left disk is recaptured and the whole delivery system is pushed inward and leftward into the left atrium where the left disk and the 2/3 of right disk are simultaneously released. This maneuver forces the left disk to become parallel to the septum preventing the protrusion of the device into the right atrium.
  
  
  RESULTS
  The ASO was successfully implanted and was associated with complete closure in 175/185 (95%) of the patients. There were no early or late complications related to the procedure during a follow-up period ranging from 6 months to 7 years.
  
  
  CONCLUSIONS
  The "Greek maneuver" is a simple quite useful trick that facilitates closure of large ASDs associated with or without deficient aortic or posterior rims.
authors.affiliation: Department of Paediatric Cardiology, Iatrikon Medical Center, Athens, Greece. Electronic address: vthanop@otenet.gr.
authors.forename: Basil D
authors.initials: BD
authors.lastname: Thanopoulos
authors.forename: Petros
authors.initials: P
authors.lastname: Dardas
authors.forename: Vlasis
authors.initials: V
authors.lastname: Ninios
authors.forename: Nicholaos
authors.initials: N
authors.lastname: Eleftherakis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Karanasios
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055989:Septal Occluder Device / Q000706:statistics & numerical data; D014463:Ultrasonography; D055815:Young Adult
keywords: Atrial septal defect; Catheter closure; Greek “maneuver