PERCUTANEOUS CLOSURE OF SECUNDUM-TYPE ATRIAL SEPTAL DEFECTS USING AMPLATZER SEPTAL OCCLUDERS

Background. Percutaneous closure of secundumtype atrial septal defect (ASD II.) is becoming an increasingly widespread alternative to surgical closure. We report our initial clinical experience with the percutaneous closure of ASD II. using Amplatzer Septal Occluders (ASO) in Slovenia. Patients and methods. Fifty consecutive patients with ASD II. were evaluated for transcatheter closure with ASO using both transthoracic (TTE) and transesophageal echocardiography (TEE). Transcatheter closure was performed under general endotracheal anesthesia with simultaneous fluoroscopy and TEE guidance. The stretch defect diameter was measured using an Amplatzer sizing balloon catheter. The ASO having a 2–4 mm larger diameter than the stretched defect diameter was selected for defect closure. Follow-up was scheduled 10 min, 24 hours, 1 month, 3 months, 6 months, 1 year and then annually after the procedure. Results. Eight patients (16%) with deficiency of the posterior, inferior anterior, or inferior posterior rim were not deemed suitable for transcatheter closure and were referred for surgery. Fourteen patients (28%) had centrally positioned defects, 23 patients (46%) defects with a deficient superior anterior rim, 3 patients had multiple defects, while 2 patients presented with atrial septal aneurysm: 1 associated with a single perforation and 1 with multiple perforations. So far, cardiac catheterization has been performed in 24 patients, while the remaining 12 patients are waiting cardiac catheterization. During cardiac catheterization, 1 additional patient was excluded from percutaneous closure due to an additional defect unsuitable for percutaneous closure. Therefore, percutaneous closure was attempted in 23 patients. In a single patient we retrieved an inadequately positioned occluder and referred the patient for elective surgical closure. A large Eustachian valve caused this single failure of occluder positioning in our series. In the remaining 22 patients successful implantation of ASO was achieved. The correct position of the occluder was achieved in 13 patients at the first attempt, while in 9 patients several attempts were necessary. The complete closure rate rose from 70% at the end of the procedure to 95% at the latest follow-up. Regression of right ventricular M-mode echocardiographic dimension was evident from 26.4 ± 3.1 mm before closure to 21.7 ± 4.2 mm at 1 month (p < 0.05), and to 19.1 ± 3.2 mm (p < 0.05) at 3 months follow-up. Late complications were not detected during a 12-month follow-up. Conclusions. Percutaneous closure of ASD II. using ASO is a safe and effective alternative to surgical closure. Up to 80% of ASD II. are amenable to percutaneous closure using ASO. Careful patient selection, precise stretch defect diameter measurement, selection of proper occluder size and precise positioning of the occluder are crucial for successful defect closure. Additional clinical experience in a larger number of patients and long-term follow-up results are required to further support our statements.