An Encouraging Approach to Complex ASDs: A Multicenter Study

Although percutaneous atrial septal defect closure is widely used, the surgical method may be preferred in cases with conditions that complicate transcatheter closure (large defect, rim deficiency or floppy rim, presence of septal aneurysm, multifenestrated defects, low age, and weight). This retrospective study evaluated data from patients with complex atrial septal defects who underwent transcatheter closure between January 2021 and August 2024. The parameters assessed included age, weight, defect size, rim size, septum characteristics, success rates, and complication rates. Transcatheter atrial septal defect closure was performed in 51 patients with complex defects. Two patients had multifenestrated defects, five had multiple defects, and 15 had an aneurysmal septum. Six patients were under one year old, and 21 had defects > 20 mm. In 25 patients, the stretched balloon size/total septum ratio was > 50%, in 44 patients, the balloon diameter/body surface area ratio was > 15 mm/m², and one had a malalignment defect. Among the patients with rim deficiency, six had isolated aortic, six had isolated inferior vena cava, five had isolated superior vena cava, and one had isolated posterior rim deficiency. Three patients had combined aortic and inferior vena cava deficiencies, and one had combined aortic and superior vena cava deficiency. The study revealed no complications except in two cases of device embolization. The success rate was 96.08% across all procedures. Percutaneous closure can be successfully performed in patients with complex atrial septal defects with low complication rates, similar to other atrial septal defects, with good results in experienced centers.