Malattached septum primum and deficient septal rim predict unsuccessful transcatheter closure of atrial communications.
OBJECTIVE
Assess impact of malattached septum primum (MASP) on transcatheter closure of interatrial communications.


BACKGROUND
Large defect size and deficient rims have been described as predictors for complications and unsuccessful device placement in closure of interatrial communications. MASP is an underappreciated morphologic atrial septal variation whose prevalence in isolated atrial communications and its influence on percutaneous device closure has not been systematically assessed.


METHODS
We retrospectively evaluated echocardiographic data of 328 patients scheduled for percutaneous secundum atrial septal defect (ASD) and patent foramen ovale (PFO) closure between January 2006 and January 2013. In ASD patients, defect size was measured by balloon stretch diameter while the length of the surrounding rims was measured in standard transthoracic and transesophageal views. Furthermore, the distance between septum primum and septum secundum as it attaches to the left atrial roof was evaluated in both, ASD and PFO patients. Septal anatomy of patients with procedural failure was compared to the anatomy of patients in whom the procedure was successful.


RESULTS
Transcatheter defect closure was successful in 131 (92.3%) of 142 ASD patients (32.3 years ± 24.7 years) and in all 186 PFO patients (49.6 years ± 16.2 years). Thirteen (4%) patients were found to have MASP (1.6 mm-13 mm). Smaller retroaortic rim, inferior rim, and the presence of a MASP were independently associated with procedural failure in ASD patients (P = 0.02, P = 0.03, and P = 0.003, respectively).


CONCLUSIONS
Smaller retroaortic and inferior rims, as well as MASP are independent risk factors for unsuccessful transcatheter ASD closure.
Division of Cardiology, Department of Pediatrics, the Mount Sinai Medical Center, New York, New York.
Stefan H
SH
Ostermayer
Division of Cardiology, Department of Pediatrics, the Mount Sinai Medical Center, New York, New York.
Shubhika
S
Srivastava
Division of Biostatistics, Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
John T
JT
Doucette
Division of Cardiology, Department of Pediatrics, the Mount Sinai Medical Center, New York, New York.
H Helen
HH
Ko
Division of Cardiology, Department of Pediatrics, the Mount Sinai Medical Center, New York, New York.
Miwa
M
Geiger
Division of Cardiology, Department of Pediatrics, the Mount Sinai Medical Center, New York, New York.
Ira A
IA
Parness
Division of Cardiology, Department of Pediatrics, the Mount Sinai Medical Center, New York, New York.
Barry A
BA
Love
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006345:Heart Septal Defects, Ventricular; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
atrial septal defect; closure; malattached septum primum; transcatheter