Morphology of perforated atrial septal aneurysm suitable for closure by transcatheter device placement
1Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. ewert@dhzb.de
Insights
A new classification system for perforated atrial septal aneurysms helps determine suitability for transcatheter closure. This approach aids in selecting patients for device closure, improving treatment outcomes for atrial septal defects.
Area of Science:
- Cardiology
- Medical Devices
- Congenital Heart Disease
Background:
- Atrial septal aneurysms with perforations present a complex challenge in congenital heart disease.
- Accurate morphological assessment is crucial for effective treatment planning.
Purpose of the Study:
- To establish morphological criteria for perforated atrial septal aneurysms to guide transcatheter device closure.
- To classify different types of perforated atrial septal aneurysms based on their morphology.
Main Methods:
- Retrospective analysis of 50 patients with atrial septal aneurysm and perforations (May 1997-June 1999).
- Classification into four types (A-D) based on aneurysm and perforation characteristics.
- Evaluation of transcatheter device closure success rates for each type.
Main Results:
- Transcatheter closure was successful in all Type A (persistent foramen ovale) and Type C (two perforations) aneurysms.
- Partial success with transcatheter closure in Type B (single defect), with four requiring surgery.
- Surgery was necessary for all Type D (multiple perforations) aneurysms.
Conclusions:
- The proposed classification system is clinically valuable for patient selection for transcatheter closure of perforated atrial septal aneurysms.
- Morphological assessment guides the choice between transcatheter device closure and surgical intervention.
Objective:
To define the morphological criteria of perforated atrial septal aneurysms suitable for closure by a transcatheter device.
Methods:
A retrospective analysis of all consecutive patients with atrial septal aneurysm and one or more perforations presenting between May 1997 and June 1999. The aneurysms were classified as: aneurysm with persistent foramen ovale (type A); aneurysm with single atrial septal defect (type B); aneurysm with two perforations requiring more than one device for closure (type C); and aneurysm with multiple perforations (type D).
Patients:
Data from 50 patients aged 5-78 years (mean 43 years) were analysed; 32 had systemic thromboembolism or transient ischaemic attacks, eight presented with dyspnoea on exercise, and 10 were discovered incidentally but had significant left to right shunt and right ventricular volume overload.
Results:
In all 18 patients with aneurysm and persistent foramen ovale (type A), transcatheter closure was possible. In nine with aneurysm and atrial septal defect (type B), five defects were closed and four required surgery. Device closure was achieved in all 10 patients with aneurysms and two perforations (type C), but four had a residual shunt. Thirteen patients with multiple perforated aneurysms (type D) underwent surgery.
Conclusions:
This classification of morphology of perforations of aneurysm is clinically useful for selecting patients for treatment by transcatheter devices.
