title: Deficient Surrounding Rims in Patients Undergoing Transcatheter Atrial Septal Defect Closure.
abstract: The influence of deficient rims surrounding atrial septal defects (ASDs) in patients undergoing transcatheter closure has yet to be clarified. The aim of this study was to assess the influence of a deficient surrounding rim on the procedural success and clinical outcome of transcatheter ASD closure using an Amplatzer septal occluder.
  
  
  
  A total of 474 patients (mean age, 46 ± 22 years) with ostium secundum ASDs measuring ≤40 mm in diameter who had undergone attempted transcatheter closure using Amplatzer septal occluders from September 2007 to August 2013 were assessed. A comprehensive transesophageal echocardiographic examination was done to assess the morphologic characteristics of the defects in all patients. Subjects were classified into three groups by the extent and location of rim deficiency (<5 mm): patients without deficient rims (sufficient group, n = 101), patients with single deficient rims, (single group, n = 338), and patients with multiple rim deficiencies (multiple group, n = 35).
  
  
  
  There was a significant difference in the maximal defect diameter among the sufficient, single, and multiple groups (15 ± 6, 18 ± 6, and 29 ± 7 mm, respectively, P < .001). Transcatheter closure was successfully accomplished in 463 patients (98%). The prevalence of procedural success differed significantly among the sufficient, single, and multiple groups (100%, 98%, and 86%, respectively, P < .001). There was no significant difference in the occurrence of cardiovascular events among the three groups during a mean follow-up period of 25 ± 19 months (P = .926, log-rank test).
  
  
  
  In patients with ASDs with multiple rim deficiencies as determined by transesophageal echocardiography, successful transcatheter ASD closure using Amplatzer septal occluders is more difficult to accomplish. However, if closure is successful, rim deficiencies rarely affect intermediate-term outcomes.
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan. Electronic address: yasufumi-kiji@nifty.com.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kijima
authors.affiliation: Cardiac Intensive Care Unit, Okayama University Hospital, Okayama, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Akagi
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaya
authors.affiliation: Cardiac Intensive Care Unit, Okayama University Hospital, Okayama, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Taniguchi
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Kusano
authors.affiliation: Cardiac Intensive Care Unit, Okayama University Hospital, Okayama, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
mesh_terms: D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055989:Septal Occluder Device / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Atrial septal defect; Congenital heart disease; Transcatheter closure; Transesophageal echocardiography