title: Transcatheter closure of large atrial septal defects: feasibility and safety in a large adult and pediatric population.
abstract: BACKGROUND
  Data are needed on the safety and efficacy of device closure of large atrial septal defects.
  
  
  RESULTS
  Between 1998 and 2013, 336 patients (161 children <15 years) with large, isolated, secundum atrial septal defects (balloon-stretched diameter ≥34 mm in adults or echocardiographic diameter >15 mm/m(2) in children) were managed using the Amplatzer device, at the Marie Lannelongue Hospital. Transthoracic echocardiographic guidance was used starting in 2005 (n=219; 65.2%). Balloon-stretched diameter was >40 mm in 36 adults; mean values were 37.6±3.3 mm in other adults and 26.3±6.3 mm/m(2) in children. Amplatzer closure was successful in 311 (92.6%; 95% confidence interval, 89%-95%) patients. Superior and posterior rim deficiencies were more common in failed than in successful procedures (superior, 24.0% versus 4.8%; P=0.002; and posterior, 32.0% versus 4.2%; P<0.001). Device migration occurred in 4 adults (2 cases each of surgical and transcatheter retrieval); in the 21 remaining failures, the device was unreleased and withdrawn. After a median follow-up of 10.0 years (2.5-17 years), all patients were alive with no history of late complications.
  
  
  CONCLUSIONS
  Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction. Long-term follow-up showed no deaths or major late complications in our population of 311 patients.
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.). a.baruteau@gmail.com.
authors.forename: Alban-Elouen
authors.initials: AE
authors.lastname: Baruteau
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Jérôme
authors.initials: J
authors.lastname: Petit
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambert
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Marielle
authors.initials: M
authors.lastname: Gouton
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Dominique
authors.initials: D
authors.lastname: Piot
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Philippe
authors.initials: P
authors.lastname: Brenot
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Claude-Yves
authors.initials: CY
authors.lastname: Angel
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Lucile
authors.initials: L
authors.lastname: Houyel
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Le Bret
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Régine
authors.initials: R
authors.lastname: Roussin
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Mohamedou
authors.initials: M
authors.lastname: Ly
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: André
authors.initials: A
authors.lastname: Capderou
authors.affiliation: From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
authors.forename: Emre
authors.initials: E
authors.lastname: Belli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology / Q000628:therapy; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: catheterization; echocardiography; heart septal defects; pediatrics