Related Experiment Video
Updated: Apr 30, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Large Amplatzer atrial septal occluder in growing children: an echographic study
Marie-Josée Raboisson1, Nicolas Hugues1, Nagib Dahdah1
1Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montreal,Quebec,Canada.
Insights
Large Amplatzer septal occluders implanted in children tend to center and move away from surrounding cardiac structures over time. This reduces the risk of long-term distortion and complications like mitral regurgitation.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Medical Device Technology
Background:
- Atrial septal defects (ASDs) closure with Amplatzer septal occluders can lead to adjacent structure lesions.
- Child cardiac growth may alter device-tissue relationships post-implantation.
Purpose of the Study:
- To assess the long-term relationship between large Amplatzer septal occluders and cardiac structures in pediatric patients.
- To evaluate changes using serial echocardiography at short, mid, and long-term follow-up.
Main Methods:
- Prospective echocardiographic evaluation of 25 children (mean age 4.6 years) with large ASD devices.
- Comparison of short-term (2 days), mid-term (17.8 months), and long-term (8.8 years) follow-up data.
Main Results:
- Increased distance between the left occluder disk and mitral valve over time (p<0.05).
- Reduced mitral regurgitation and fewer devices straddling the aorta at long-term follow-up (p<0.05).
- Initial venous protrusion resolved by long-term follow-up.
Conclusions:
- Large Amplatzer devices demonstrate a tendency to self-center and move away from adjacent structures.
- This repositioning decreases the risk of long-term cardiac distortion and related complications.
Background:
Lesions of adjacent structures have been reported after closure of large atrial septal defects with the Amplatzer septal occluder. In children, growth of the heart should modify the initial relationship between the device and surrounding structures.
Aim:
To compare the relationship between large Amplatzer septal occluder and adjacent cardiac structures at short-, mid-, and long-term follow-up in at-risk paediatric population using echocardiography.
Methods:
A total of 25 children (4.6±2.9 years old, 18 girls) with the largest atrial septal defect devices implanted between 1997 and 2002 were enrolled prospectively for complete echocardiogram 17.8±10.5 months (mid-term follow-up) and 8.8±0.9 years (long-term follow-up) after the procedure. RESULTS were compared with the echocardiogram carried out 2.1±3.4 days after the procedure (short-term follow-up).
Results:
The minimal distance between the left disk and the mitral valve increased: 1.4±2.0 mm at short-term and 5.1±2.3 mm at long-term follow-up (p<0.05), leading to less contact between the disk and the anterior leaflet and less mitral regurgitation (10 at short-term, 4 at long-term follow-up, p<0.05). The number of devices straddling the aorta decreased from 17 to 12 at long-term follow-up (p<0.05). There was protrusion of disk in the venous structure in seven patients on the first echocardiogram, which disappeared at long-term follow-up.
Conclusion:
Although frequently in close contact with the aortic root, mitral valve, or venous returns, large devices tend to centre and move away from the surrounding structures, with decreased risk for long-term distortion.
