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Updated: Dec 21, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Percutaneous closure of residual atrial septal defect after surgical closure
Soichiro Ogura1, Yoichi Takaya2, Teiji Akagi2
1Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan. p2q24y3k@s.okayama-u.ac.jp.
Insights
Percutaneous closure effectively treats residual atrial septal defects (ASD) after surgery when redo surgery is not an option. This minimally invasive approach offers a safe and successful alternative for patients with residual ASD.
Area of Science:
- Cardiology
- Interventional Cardiology
- Adult Congenital Heart Disease
Background:
- Residual atrial septal defect (ASD) after surgical repair is uncommon but can occur.
- Redo surgery for residual ASD is often challenging, leading to interest in alternative treatments.
- Established indications for percutaneous closure of residual ASD are lacking.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous closure for residual ASD.
- To analyze patient characteristics and outcomes following percutaneous closure of residual ASD.
Main Methods:
- Retrospective review of medical and procedural records from 2006-2018.
- Inclusion of seven patients with residual ASD after prior surgical closure.
- Assessment of percutaneous closure success and follow-up for residual shunts.
Main Results:
- Seven patients (median age 66 years) with symptomatic residual ASD underwent successful percutaneous closure.
- No residual shunts were detected during a median follow-up of 4.2 years.
- Potential causes identified include suture line dehiscence or missed defects during initial surgery.
Conclusions:
- Percutaneous closure is a safe and effective therapeutic strategy for residual ASD.
- This approach provides a viable alternative to redo surgery for selected patients.
- Further research may help establish definitive indications for percutaneous closure of residual ASD.
Abstract:
Residual atrial septal defect (ASD) after surgical closure is rare, but some cases are seen during follow-up period. Redo surgery for residual ASD is often declined, while percutaneous closure can be acceptable. However, the indication of percutaneous closure for residual ASD has not been established. We reviewed our experience with percutaneous closure of residual ASD using medical and procedural records. Between 2006 and 2018, residual ASD was seen in seven patients. The median age of patients was 66 years (range 50-81 years), and the median period after surgical closure of ASD was 39 years (range 13-48 years). All patients had symptoms related to ASD. Percutaneous closure of residual ASD was successfully performed in all seven patients. No residual shunts were detected during the median follow-up period of 4.2 years (range 0.5-11 years) after percutaneous closure. Based on transesophageal echocardiographic findings and operative records for surgical closure, we considered two mechanisms causing residual ASD, such as the tear of surgical suture line and the overlooking of defect during surgical closure. Percutaneous closure of residual ASD was safely performed without any complications, suggesting that percutaneous is an effective therapeutic strategy for residual ASD after surgical closure.
