Transcatheter closure of atrial septal defect using buttoned device--Indian experience

Area of Science:

• Cardiology
• Interventional Cardiology
• Pediatric Cardiology

Background:

• Secundum atrial septal defects (ASD) are common congenital heart abnormalities.
• Transcatheter closure offers a minimally invasive alternative to surgical repair.
• Accurate device selection and implantation are crucial for successful outcomes.

Purpose of the Study:

• To evaluate the safety and efficacy of the Sideris buttoned device for transcatheter closure of secundum ASD.
• To assess the accuracy of transthoracic echocardiography (TTE) in measuring ASD diameter compared to balloon sizing.
• To report procedural success rates, shunt status, and long-term device stability.

Main Methods:

• Transcatheter closure was attempted in 27 patients (age 5-35 years) with ASD < 21 mm using the Sideris device.
• Fluoroscopic and TTE guidance were employed throughout the procedure.
• ASD diameter was assessed by TTE and balloon sizing during cardiac catheterization.

Main Results:

• Successful device implantation was achieved in 24 patients (89%).
• Complete shunt closure was observed in 17 patients (63%) by TTE.
• Residual shunts were noted in 7 patients, with device stability in all patients on follow-up (14.5 months).
• Complications included device unbuttoning/slippage (3 patients) and new-onset mitral regurgitation (5 patients).

Conclusions:

• Transcatheter closure of selected secundum ASDs with the Sideris device is feasible and safe.
• The Sideris device may be less suitable for larger defects, potentially impacting mitral valve function.
• Centering devices might offer better outcomes for larger ASDs with reduced mitral valve interference.