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Updated: Jun 16, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Long-term follow up of secundum atrial septal defect closure with the amplatzer septal occluder
Marc D Knepp1, Albert P Rocchini, Thomas R Lloyd
1University of Michigan Congenital Heart Center-Department of Pediatrics, Ann Arbor, MI 48109, USA. mknepp@umich.edu
Insights
The Amplatzer septal occluder (ASO) is a safe and effective device for closing secundum atrial septal defects (ASD), with a high closure rate and low incidence of residual shunts and arrhythmias over 10 years. Further research on anti-platelet therapy is suggested.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Secundum atrial septal defect (ASD) closure has transitioned from surgical to percutaneous transcatheter methods.
- Few long-term efficacy and safety studies exist for the Amplatzer septal occluder (ASO).
Purpose of the Study:
- To evaluate the long-term efficacy and safety of secundum ASD closure using the Amplatzer septal occluder (ASO).
Main Methods:
- A review of data from 94 patients who underwent secundum ASD closure with ASO between 1998 and 2002.
- Collection of data on residual shunt, chest pain, palpitations, arrhythmias, headaches, transient ischemic attacks, cerebrovascular accidents, and mortality.
Main Results:
- A 97% complete closure rate was achieved, with only 7.4% residual shunts initially.
- Low incidence of arrhythmias (7%), new-onset migraines (4%), and mild aortic insufficiency (1%).
- One high-risk patient experienced a fatal cerebrovascular event 18 months post-implantation.
Conclusions:
- The Amplatzer septal occluder (ASO) demonstrates continued safety up to 120 months post-implantation for secundum ASD closure.
- Low rates of residual shunts and arrhythmias are observed.
- Further investigation into anti-platelet therapy post-ASO placement is warranted, especially in high-risk patients.
Background:
During the past 15 years, closure of a secundum atrial septal defect (ASD) has moved from a surgical to a percutaneous transcatheter approach. Few long-term studies of the efficacy and safety of closure of an ASD by an Amplatzer septal occluder (ASO) exist.
Methods:
To examine the long-term results of secundum ASD closure using the ASO, data on 94 patients who underwent secundum ASD closure with the ASO between 1998 and 2002 were available and reviewed. Data regarding residual shunt, chest pain, palpitations, arrhythmias, headaches, transient ischemic attacks, cerebrovascular accidents, and mortality were collected.
Results:
Seven (7.4%) subjects had residual shunts immediately following ASO placement. During follow-up, 4 residual shunts closed for a complete closure rate of 97%. Eighteen (19%) patients reported chest pain during the follow-up period. Twenty-three patients (24%) reported palpitations during the follow up period, 7 were documented arrhythmias, including supraventricular tachycardia, atrial fibrillation, and premature ventricular beats. Migraine headaches were new-onset in 4 patients. Migraine cessation occurred in 2 patients after secundum ASD closure. One child died from a cerebral vascular event 18 months following device placement. Only 1 patient developed mild aortic insufficiency.
Conclusion:
These data indicate that for up to 120 months of patient follow-up, the ASO continues to be a safe device. Residual shunts and arrhythmias have low incidence post-ASO placement. Given the mortality in one high-risk patient, further investigation into anti-platelet therapy after device placement is warranted.
