title: Percutaneous closure of secundum type atrial septal defects: More than 5-year follow-up.
abstract: OBJECTIVE
  To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect (ASD) closure in adults.
  
  
  METHODS
  All patients who underwent percutaneous closure of an ASD in the St. Antonius Hospital, Nieuwegein, The Netherlands, between February 1998 and December 2006 were included. Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic monitoring. Transthoracic echocardiography (TTE) was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler. All complications were registered. All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure. Efficacy was based on the presence of a residual right-to-left shunt (RLS), graded as minimal, moderate or severe. The presence of a residual left-to-right shunt (LRS) was diagnosed using color Doppler, and was not graded. Descriptive statistics were used for patients' characteristics. Univariate analysis was used to identify predictors for residual shunting.
  
  
  RESULTS
  In total, 104 patients (mean age 45.5 ± 17.1 years) underwent percutaneous ASD closure using an Amplatzer device (ASO) in 76 patients and a Cardioseal/Starflex device (CS/SF) in 28 patients. The mean follow-up was 6.4 ± 3.4 years. Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization (1 ASO, 1 CS/SF). The other 2 cases of device migration occurred during the first 6 mo of follow-up (2 CS/SF). The recurrent thrombo-embolic event rate was similar in both groups: 0.4% per follow-up year. More than 12 mo post-ASD closure and latest follow-up, new-onset supraventricular tachyarrhythmia's occurred in 3.9% and 0% for the ASO and CS/SF group, respectively. The RLS rate at latest follow-up was 17.4% (minimal 10.9%, moderate 2.2%, severe 4.3%) and 45.5% (minimal 27.3%, moderate 18.2%, severe 0%) for the ASO- and CS/SF groups, respectively. There was no residual LRS in both groups.
  
  
  CONCLUSIONS
  Percutaneous ASD closure has good long-term safety and efficacy profiles. The residual RLS rate seems to be high more than 5 years after closure, especially in the CS/SF. Residual LRS was not observed.
authors: Roel JR Snijder, Maarten J Suttorp, Jurriën M Ten Berg, Martijn C Post, Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
authors: Roel Jr
authors: RJ
authors: Snijder
authors: Roel JR Snijder, Maarten J Suttorp, Jurriën M Ten Berg, Martijn C Post, Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
authors: Maarten J
authors: MJ
authors: Suttorp
authors: Roel JR Snijder, Maarten J Suttorp, Jurriën M Ten Berg, Martijn C Post, Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
authors: Jurriën M Ten
authors: JM
authors: Berg
authors: Roel JR Snijder, Maarten J Suttorp, Jurriën M Ten Berg, Martijn C Post, Department of Cardiology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
authors: Martijn C
authors: MC
authors: Post
keywords: Atrial septal defect; Closure device; Echocardiography; Left-to-right interatrial shunt; Percutaneous intervention; Right-to-left interatrial shunt