Related Experiment Video
Updated: May 11, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
[Percutaneous transcatheter atrial septal defect closure with Amplatzer septal occluder device using three different
Teoman Kılıç1, Tayfun Sahin, Ertan Ural
1Department of Cardiology, Kocaeli University Faculty of Medicine, Turkey. kilicteoman@yahoo.com
Insights
Transcatheter closure of complex atrial septal defects (ASDs) using the Amplatzer septal occluder (ASO) can be challenging. Specialized techniques, including pulmonary vein and atrial roof approaches, improve procedural success for these complex cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Complex ostium secundum atrial septal defects (ASDs) present challenges for transcatheter closure.
- Standard Amplatzer septal occluder (ASO) implantation may be difficult in large, multiple, or multi-fenestrated ASDs with abnormal septal rims.
Observation:
- This report details three adult cases of complex ASD closure using ASO devices.
- Techniques employed included a left upper pulmonary vein approach, a left atrial roof technique with a non-inflated balloon, and a partially inflated balloon technique.
Findings:
- Successful closure of complex ASDs was achieved in all three patients using tailored ASO device implantation techniques.
- The specific techniques facilitated proper device deployment and orientation of the left atrial disc parallel to the septum.
Implications:
- Knowledge and application of diverse techniques are crucial for increasing the success rate of transcatheter ASD closure in complex cases.
- These alternative methods can potentially reduce complications associated with complex atrial septal defect interventions.
Abstract:
Complex ostium secundum type atrial septal defect (ASD) is a definition used for large (stretched diameter over 26 mm with deficient rim) or multiple ASDs or multi-fenestrated septum or ASDs with redundant and aneurysmal septal rims. Compared to simple defects, transcatheter ASD closure with Amplatzer septal occluder (ASO) is relatively challenging in these cases, and different techniques have been defined to increase procedure success. We report three adult patients with complex ostium secundum type ASDs that were closed with ASO device using three different techniques. The first case was a 36-year-old female patient with complaints of dyspnea, palpitation and fatigue. A complex ostium secundum type ASD was diagnosed, and the defect was closed with a 36 mm ASO device using a left upper pulmonary vein technique. The second case was a 47-year-old female patient with complaints of dyspnea and palpitation. A large and complex ASD was detected, and the defect was closed with a 28 mm device using a left atrial roof technique supported by non-inflated balloon. The third case was a 40-year-old female patient who presented with complaints of dyspnea and palpitation. Complex ASD was diagnosed, and the defect was closed with a 32 mm device using a partially inflated balloon technique. In large and complex ASDs, the classical implantation technique of an ASO device may fail at any time. The knowledge and application of different techniques that orient the left atrial disc parallel to the septum may increase the procedure success and decrease complications.
