title: Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects.
abstract: BACKGROUND
  Very few published data is available on the outcomes of balloon assisted techniques (BATs) for trans catheter closure (TCC) of very large (Defined as ≥35 mm size) ostium secundum atrial septal defect (ASD).
  
  
  OBJECTIVE
  To study the utility of BAT as against conventional techniques (CT) in TCC of very large ostium secundum ASD (≥35 mm) over the past 5-year period and to find out the association of different morphological features of the defects in relation to TCC outcomes.
  
  
  METHODS
  Descriptive single center retrospective study of patients with very large ostium secundum ASD (≥35 mm size) who were subjected to TCC.
  
  
  RESULTS
  Thirty-three out of 36 patients with ≥35 mm ASD and complex morphological features underwent successful TCC. The study patients had high prevalence of absent aortic and posterior rims with posterior mal-alignment of the septum. BAT was successful in 28/31 (90.3%) patients while CT had a success rate of 16%. The mean trans-esophageal echocardiography (TEE) ASD size with BAT success 37 (SD 1.3) mm and CT failure 36.2 (SD 1.1) mm was not different (P=0.06). On univariate analysis of different morphological features, posterior mal alignment of the septum was associated failure of CT (P=0.01). There was no urgent referral for surgery and patients did well on follow up.
  
  
  CONCLUSIONS
  Balloon assisted device closure of (≥35 mm) ASD had 90% success rate. BAT helps in controlled delivery and device alignment in very large ASD with posterior malalignment of the septum and is often helpful when CT fails.
authors.affiliation: Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India.
authors.forename: Ajith Ananthakrishna
authors.initials: AA
authors.lastname: Pillai
authors.affiliation: Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India.
authors.forename: Vidhyakar
authors.initials: V
authors.lastname: Rangaswamy Balasubramanian
authors.affiliation: Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India.
authors.forename: Raja
authors.initials: R
authors.lastname: Selvaraj
authors.affiliation: Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India.
authors.forename: Maheshkumar
authors.initials: M
authors.lastname: Saktheeswaran
authors.affiliation: Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India.
authors.forename: Santhosh
authors.initials: S
authors.lastname: Satheesh
authors.affiliation: Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India.
authors.forename: Balachander
authors.initials: B
authors.lastname: Jayaraman
keywords: Very large atrial septal defect (very large ASD); balloon assisted technique (BAT); malaligned septum