[Repair of interatrial septal defect with an Amplatzer device. Experience with 3 cases]
Jaime E Munayer Calderón1, Carlos Zabal Cerdeira, José Luis Lázaro Castillo
1Departamento de Hemodinamia, Hospital General CMN, La Raza.
Insights
Transcatheter closure of atrial septal defects (ASD) using Amplatzer devices proved effective, even in complex cases lacking an inferior septal border. This minimally invasive technique achieved 100% occlusion and positive patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Context:
- Atrial septal defects (ASDs) are common congenital heart anomalies.
- Transcatheter closure offers a less invasive alternative to surgical repair.
- Complex ASD anatomies, including those lacking a defined inferior border, pose challenges for device implantation.
Purpose:
- To evaluate the efficacy and safety of Amplatzer device closure for ostium secundum ASDs.
- To assess the feasibility of Amplatzer device implantation in patients with challenging septal anatomy, specifically absent inferior borders.
- To report outcomes in pediatric and adult patients undergoing transcatheter ASD closure.
Summary:
- Three patients (ages 4, 12, and 54 years) with ostium secundum ASD underwent successful transcatheter closure using Amplatzer devices.
- Device implantation was technically successful despite challenging anatomy, including absent inferior borders in two patients.
- All patients achieved 100% occlusion and remained asymptomatic with no residual shunt at one-month follow-up.
Impact:
- The Amplatzer device is a safe and effective option for ASD closure, even in cases with limited anatomical support.
- This technique simplifies the management of complex ASDs, potentially reducing the need for surgery.
- Demonstrates the versatility of Amplatzer devices in achieving successful closure across a range of ASD sizes and anatomical variations.
Abstract:
We performed transcatheter closure of an atrial septal defect (ASD) using an Amplatzer device in three patients, 2 women and 1 male child, aged 12, 54, and 4 years, respectively, coursing with ostium secundum ASD. Two with left to right shunt and the third with bidirectional shunt. The transesophageal echocardiogram revealed ASD with diameters of 13, 15, and 10 mm, the diameter with expanded catheter balloon was of 30, 26, and 17 mm, respectively. The superior border of the atrial septum was bigger than 5 mm in all three patients, whereas the inferior border could not be found through echocardiography in the patients aged 12 and 4 years. Amplatzer devices of 30, 26, and 17 mm were implanted, the inferior border of the first two could be supported on the aortic wall and the superior border on the septum. We observed a 100% occlusion in these two cases through ecocolor-Doppler. In the third patient, an inferior border of 16 mm and a superior border of 8 mm were determined, achieving and immediate and fast installation of the device with 100% occlusion. All three patients were in stable conditions, asymptomatic and without shunt at their one-month follow-up as revealed by a trans-thoracic echocardiography. It is concluded that the Amplatzer device is technically easy to install and yields adequate results even in patients with ample ASD and without inferior border of the inter-atrial septum.
