Transvenous closure of moderate and large secundum atrial septal defects in adults using the Amplatzer septal occluder
1Department of General Cardiology, Institute of Cardiology, Warsaw, Poland. mdemkow@ikard.waw.pl
Insights
The Amplatzer septal occluder effectively closes moderate to large secundum atrial septal defects in adults. This transvenous procedure is safe and offers a high rate of complete occlusion, serving as a viable surgical alternative.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Secundum atrial septal defects (ASDs) are common congenital heart conditions.
- Surgical closure has historically been the primary treatment for moderate to large ASDs.
- Transcatheter device closure offers a less invasive alternative.
Purpose of the Study:
- To evaluate the feasibility and safety of using the Amplatzer septal occluder for adult secundum ASD closure.
- To assess the efficacy of the device in achieving complete occlusion.
- To identify patient and defect characteristics influencing procedural success.
Main Methods:
- Prospective study involving 50 adult patients with moderate to large secundum ASDs.
- Successful implantation of Amplatzer septal occluders.
- Echocardiographic and balloon sizing of defects and devices.
- Follow-up at 1, 3, and 12 months to assess occlusion rates and complications.
Main Results:
- Successful device implantation in all 50 patients.
- High rates of complete occlusion: 90% at 1 month, 92% at 3 months, and 98% at 12 months.
- Minimal and transient complications, including one case of atrioventricular block and one of STT elevation.
Conclusions:
- Transvenous occlusion of secundum ASDs with the Amplatzer septal occluder is safe and effective in adults.
- The device is suitable for various defect types, including large, complex, and those with deficient rims.
- This procedure is a safe and effective alternative to surgery for selected adult patients.
Abstract:
The aim was to determine the feasibility of using the Amplatzer septal occluder for closure of moderate and large secundum atrial septal defects in adults. Fifty patients aged 16-76 years (mean +/- SD, 40 +/- 15.5), underwent successful device implantation. Flow ratios of 1.4-8.5 (mean +/- SD, 2.6 +/- 1.6) were calculated. The defects were: centrally placed (n = 31), antero-superior with partial or total deficiency of aortic rim (n = 19), multiple (n = 3) and with aneurysmal septum (n = 23). They measured 4-25 mm (median 14) on echocardiography and balloon sized 7-31 mm (median 19.5). Devices of 7-34 mm (median 20) were implanted. Patient follow up for 1 month (50/50 patients), 3 months (40/50) and 12 months (13/50), achieved respective rates of 90%, 92% and 98% of complete occlusion. In one patient a transient atrioventricular block (2:1) developed, and one had a transient STT elevation. One female had an episode of 30 min loss of vision over the lateral aspect of the left eye 3 months after implantation. In conclusion, transvenous occlusion of secundum atrial septal defects with the Amplatzer septal occluder in adults is safe, and can be performed without significant complications. Large defects, defects with a very deficient or absent aortic rim, defects with an aneurysmal septum as well as some multiple defects can be closed with an almost 100% early complete occlusion rate. This makes the procedure an alternative to surgery for selected adult patients.
