title: Closure of Interatrial Septal Communications: Adverse Events and Lessons Learned.
abstract: BACKGROUND
  Percutaneous closure of interatrial septal communications (IASC) is generally being regarded as a safe and straightforward intervention. Reporting and classification of adverse events (AE) as is the case for percutaneous coronary intervention (PCI) is not standardized. Also, the focus of reported larger studies has not been primarily on AE and strategies to avoid them.
  
  
  METHODS
  The data of all 112 consecutive patients undergoing IASC by a single operator were reviewed. In analogy to classification for PCI, an AE was considered to be major if any of the following occurred: death, major or minor stroke, myocardial infarction, the need for an originally unplanned additional surgery or intervention or blood transfusion. Every AE and how it may have been avoided is reviewed in detail.
  
  
  RESULTS
  Major AE according to the suggested classification occurred in 2.7% of patients, including tamponade in 1 patient necessitating thoracotomy 7 months after IASC, percutaneous retrieval of an embolized device in 1 patient, and ambulatory same day surgical treatment of an arteriovenous fistula in 1 patient.
  
  
  CONCLUSIONS
  The proposed new classification of AE provides a unified and comparable approach for IASC procedures. Retrospectively, two of the 3 major AE could have probably been avoided by more thoughtful patient and material selection.
authors.affiliation: HerzZentrum Hirslanden, Witellikerstrasse 36, 8008 Zurich, Switzerland. Email: wagdi@herzzentrum.ch.
authors.forename: Philipp
authors.initials: P
authors.lastname: Wagdi
keywords: Adverse events; Atrial septal defect; Classification; Patent foramen ovale; Percutaneous closure