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Device closure of atrial septal defect: medium-term outcome with special reference to complications

  • Masood Sadiq (a1), Tehmina Kazmi (a1), Asif U. Rehman (a2), Farhan Latif (a2), Najam Hyder (a1) and Shakeel A. Qureshi (a3)...

Abstract

Background

There are concerns over the outcome of device closure of secundum atrial septal defect with special reference to erosions and aortic regurgitation.

Aim

To assess the medium-term outcome of device closure of atrial septal defects with special reference to complications.

Methods

A total of 205 patients with secundum atrial septal defects underwent transcatheter closure from October, 1999 to April, 2009. The median age was 18 (1.4–55) years. Amplatzer Septal Occluder was used in all the patients. Medium-term follow-up was available in 176 of 200 (88%) patients.

Results

Device closure was successful in 200 out of 205 (98%) patients. The device embolised in four patients and was associated with short inferior caval vein margin (p = 0.003). Balloon sizing in 71 patients (35%) resulted in implantation of a larger device (p = 0.002). Early complications included pericardial effusion, 2:1 heart block, and infective endocarditis (1 patient each). There were eight patients who reported migraine (3.9%). At median follow-up of 5.8 (0.6–10.3) years, complete closure occurred in 197 out of 200 patients. Short superior caval vein margin was associated with a residual shunt (p < 0.001). There were two patients who developed mild aortic regurgitation (1%), which correlated with a device-to-defect ratio of >1.3:1 (p = 0.001). There were no erosions, late embolisation, or thromboembolism. Atrial fibrillation occurred in three adults (1.5%).

Conclusions

Device closure of secundum atrial septal defects using Amplatzer Septal Occluder is safe and effective in the medium term. Short inferior caval vein margin correlates with increased risk of embolisation and short superior caval vein margin with a residual shunt. The risk of developing aortic regurgitation is low and correlates with increased device-to-defect ratio.

Copyright

Corresponding author

Correspondence to: Professor Dr Masood Sadiq, FRCPCH, FRCP(Ed), Head Department of Paediatric Cardiology, The Children's Hospital and Institute of Child Health, Ferozepur Road, Lahore, Pakistan. Tel: 0092-42-99231723; Fax: 0092-42-99230358; E-mail: drmasoodsadiq@hotmail.com

References

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1. Vogel, M, Berger, F, Dahnert, I, Ewert, P, Lange, PE. Treatment of atrial septal defects in symptomatic children aged less than 2 years of age using the Amplatzer septal occluder. Cardiol Young 2000; 10: 534537.
2. Masura, J, Gavora, P, Formanek, A, et al. Transcatheter closure of secundum atrial septal defects using the new self-centring Amplatzer septal occluder: initial human experience. Cathet Cardiovasc Diagn 1997; 42: 388393.
3. Wilkinson, JL, Goh, TH. Early clinical experience with use of the “Amplatzer septal occluder” device for atrial septal defect. Cardiol Young 1998; 8: 295302.
4. Chan, KC, Godman, MJ, Walsh, K, Wilson, N, Redington, A, Gibbs, JL. Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding Nitinol double disc device (Amplatzer septal occluder): multicentre UK experience. Heart 1999; 82: 300306.
5. Hijazi, ZM, Cao, Q, Patel, H, Rhodes, J. Transcatheter closure of atrial communications using the Amplatzer septal occluder. J Interv Cardiol 1999; 12: 5157.
6. Berger, F, Ewert, P, Bjorn tad, PG, et al. Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer septal occluder. Cardiol Young 1999; 9: 468473.
7. Chessa, M, Carminati, M, Butera, G, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol 2002; 39: 10611065.
8. Knepp, MD, Rocchini, AP, Lloyd, TR, Aiyagari, RM. Long-term follow up of secundum atrial septal defect closure with the Amplatzer septal occluder. Congenital Heart Disease 2010; 5: 3237.
9. Spence, MS, Qureshi, SA. Complications of transcatheter closure of atrial septal defects. Heart 2005; 9: 15121514.
10. Amin, Z, Hijazi, ZM, Bass, JL, Cheatham, JP, Hillenbrand, WE, Kleinmann, CS. Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects: review of registry of complications and recommendations to minimize future risk. Cathet Cardiovasc Interv 2004; 63: 496502.
11. Schoen, SP, Boscheri, A, Lange, SA, et al. Incidence of aortic valve regurgitation and outcome after percutaneous closure of atrial septal defects and patent foramen ovale. Heart 2008; 94: 844847.
12. Sadiq, M, Akram, Z, Butt, M. Transcatheter occlusion of Secundum atrial septal defects with Amplatzer Septal Occluder – initial experience. Pakistan J Cardiol 2001; 12: 6166.
13. Pondar, T, Martanovic, P, Gavora, P, Masura, J. Morphological variations of secundum-type atrial septal defects: feasibility for percutaneous closure using Amplatzer septal occluder. Cathet Cardiovasc Interv 2001; 53: 386391.
14. Shrivastava, S, Radhakrishnan, S. Echocardiographic anatomy of the atrial septal defects: “nomenclature of rims”. Ind Heart J 2003; 55: 8889.
15. Dalvi, B. Balloon assisted technique for closure of large atrial septal defects. Images Paediatr Cardiol 2008; 37: 59.
16. Divekar, A, Gaamangwe, T, Shaikh, N, Raabe, M, Ducas, J. Cardiac perforation after device closure of atrial septal defects with the Amplatzer septal occluder. J Am Coll Cardiol 2005; 45: 12131218.
17. Fischer, G, Stieh, J, Uebing, A, Hoffmann, U, Morf, G, Kramer, H. Experience with transcatheter closure of Secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart 2003; 89: 199204.
18. Raghuram, RA Krishnan, R, Kumar, S, Balamurugan, K. Complications in atrial septal defect device closure. Cathet Cardiovasc Interv 2004; 63: 496502.
19. Rao, PS, Berger, F, Rey, C, et al. International Buttoned Device Trial Group. Results of transvenous occlusion of secundum atrial septal defects with the fourth generation buttoned device: comparison with first, second and third generation devices. J Am Coll Cardiol 2000; 36: 583592.
20. Worms, AM, Rey, C, Bourlon, F, et al. Experience francaise de la fermeture des communications interauruculaires de type ostium secundum par la prothese boutonnee de Sideris. Arch Mal Coeur Vaiss 1996; 89: 509515.
21. Krumsdorf, U, Ostermayer, S, Billinger, K, et al. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol 2004; 43: 302305.
22. Scholtz, W, Jategaonkar, S, Faber, L. Unusual complication with transcatheter closure of an atrial septal defect prevented by adequate imaging. Images in cardiovascular medicine. Circulation 2008; 117: 181183.
23. Shaheen, J, Alper, L, Rosenmann, D, et al. Effect of surgical repair of secundum-type atrial septal defect on right atrial, right ventricular, and left ventricular volumes in adults. Am J Cardiol 2000; 86: 13951397.
24. Gomez, C, Ludomirsky, A, Ensing, G, Rocchini, A. Effect of acute changes in load on left ventricular diastolic function during device closure of atrial septal defects. Am J Cardiol 2009; 95: 686688.
25. Schubert, S, Peters, B, Abdul-Khaliq, H, Nagdyman, N, Lange, PE, Ewert, P. Left ventricular conditioning in the elderly patient to prevent congestive heart failure after transcatheter closure of atrial septal defect. Cathet Cardiovasc Interv 2005; 64: 333337.
26. Gatzoulis, MA, Freeman, MA, Siu, SC, Webb, GD, Harris, L. Atrial arrhythmia after surgical closure of atrial septal defects in adults. NEJM 1999; 340: 839846.
27. Ghosh, S, Chatterjee, S, Black, E, Firmin, RK. Surgical closure of atrial septal defects in adults: effect of age at operation on outcome. Heart 2002; 88: 485487.
28. Jategaonkar, S, Scholtz, W, Schmidt, H, Horstkotte, D. Percutaneous closure of atrial septal defects: echocardiographic and functional results in elderly patients over 60 years. Circ Cardiovasc Interv 2009; 2: 8589.
29. Nehgme, RA, Huddleston, AR, Cheatham, JP. Progression to late complete atrioventricular block following Amplatzer device closure of atrial septal defect in a child. Pediatr Cardiol 2009; 30: 367370.
30. Massin, MM, Dessy, H, Malekzadeh-Milani, SG, Khaldi, K, Topac, B, Edelman, R. Chronotropic impairment after surgical or percutaneous closure of atrial septal defect. Cathet Cardiovasc Interv 2009; 73: 564567.
31. Suda, K, Raboisson, MJ, Piette, E, Dahdah, NS, Miró, J. Reversible atrioventricular block associated with closure of atrial septal defects using the Amplatzer device. J Am Coll Cardiol 2004; 43: 16771682.

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