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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

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Malattached septum primum and deficient septal rim predict unsuccessful transcatheter closure of atrial

Stefan H Ostermayer1, Shubhika Srivastava1, John T Doucette2

  • 1Division of Cardiology, Department of Pediatrics, the Mount Sinai Medical Center, New York, New York.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|September 3, 2015
PubMed
Abstract

Insights

Malattached septum primum (MASP) and deficient septal rims are key predictors of unsuccessful transcatheter closure for atrial septal defects (ASDs). Understanding these anatomical variations improves procedural success rates in patients undergoing interatrial communication closure.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Transcatheter closure of interatrial communications can be complicated by large defect size and deficient rims.
  • Malattached septum primum (MASP) is an underappreciated anatomical variation affecting atrial septal closure.
  • The prevalence and impact of MASP on percutaneous closure of atrial communications remain under-evaluated.

Purpose of the Study:

  • To assess the impact of malattached septum primum (MASP) on transcatheter closure of interatrial communications.
  • To identify anatomical predictors of procedural failure in transcatheter closure of secundum atrial septal defects (ASDs) and patent foramen ovale (PFO).

Main Methods:

  • Retrospective evaluation of echocardiographic data from 328 patients undergoing ASD or PFO closure.
  • Measurement of defect size, rim length, and MASP presence using transthoracic and transesophageal echocardiography.
  • Comparison of septal anatomy between patients with successful and failed procedures.

Main Results:

  • Transcatheter closure was successful in 92.3% of ASD patients and 100% of PFO patients.
  • Malattached septum primum (MASP) was identified in 4% of patients.
  • Smaller retroaortic rim, inferior rim, and the presence of MASP were independently associated with procedural failure in ASD closure.

Conclusions:

  • Smaller retroaortic and inferior rims are independent risk factors for unsuccessful transcatheter ASD closure.
  • Malattached septum primum (MASP) is an independent risk factor for unsuccessful transcatheter ASD closure.
  • Identifying these anatomical factors can help predict and potentially mitigate procedural failures.
Keywords:
atrial septal defectclosuremalattached septum primumtranscatheter

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