Feasibility of Transcatheter Closure of Large Secundum Atrial Septal Defect with Absent Superior or Inferior Rim

Area of Science:

• Cardiology
• Interventional Cardiology
• Congenital Heart Disease

Background:

• Surgical closure is standard for large secundum atrial septal defects (ASDs) lacking superior or inferior rims.
• Transcatheter closure presents a potential alternative for these complex cases.

Purpose of the Study:

• To evaluate the feasibility, effectiveness, and safety of transcatheter closure for large secundum ASDs with absent rims.
• To assess the use of Cheatham Platinum (CP) stents to create rims for subsequent closure with septal occluders.

Main Methods:

• A case series involving five patients with large secundum ASDs and absent superior or inferior rims.
• Implantation of CP stents at the superior vena cava (SVC) or inferior vena cava (IVC) entrance to the right atrium (RA).
• Subsequent closure of the ASD using atrial septal occluders.

Main Results:

• Successful transcatheter closure was achieved in all five patients.
• CP stents effectively created rims for septal occluders in defects with absent superior or inferior rims.
• Specific stent and occluder sizes were used based on defect characteristics.

Conclusions:

• Transcatheter closure of large secundum ASDs with absent rims is possible and effective using CP stents.
• This approach requires challenging interventional techniques, particularly for defects with absent inferior rims.
• Recommendations include using specific CP stent configurations to mitigate risks like stent migration.