Abstract 13455: Consecutive and Systematic Transcatheter Closure of Secundum Atrial Septal Defects with the Amplatzer Septal Occluder: a Single Center Study on Pediatric Patients
Introduction: Transcatheter closure of ostium secundum atrial septal defect (OSASD) has gradually replaced surgical closure. Most centers are selective for surgical versus percutaneous approach. In 2000 we adopted a universal percutaneous approach with the Amplatzer device for all cases referred to our clinic.
Objectives: To evaluate the safety and efficacy of universal transcatheter policy in a consecutive pediatric population from a single institution.
Methods: Between August 2000 and August 2008 all children with a significant OSASD were considered for transcatheter closure regardless of OSASD size, number, or septal margins. Only patients with concomitant defects requiring surgical intervention were surgically approached.
Results: 253 patients, age 6.5±4.4 years [5.05;8.5-58.6] [median; 5th-95th pc], weight 23.7±15.5 kg [17.8;8.5-58.6], underwent percutaneous intervention. During this period one patient underwent direct surgical ASD closure based on his treating physician choice. Isolated OSASD were present in 201 patients (79.4%), pulmonary stenosis was associated in 30 (11.8%), 11 of whom required concomitant balloon valvuloplasty. Qp:Qs was 1.97±0.98 [1.73;1.1-3.4]. Deficient IVC ring was present in 23 patients (9%). Procedural success was 100%, with procedure time 116.7±33.1 minutes [117;67.8-175.0], fluoroscopy time 20.6±9.0 minutes [19;9-38.7], and implanted device diameter 19.9±6.3mm [19;11-32]. Mild or moderate residual shunt at 24 hours was noted in 33 (13.3%) and in 3 patients (1.2%) respectively. After a 33.3±25.8 months follow-up [29.4;0.36-79.5] complete closure was documented in 98.4%, with a trivial to mild residual shunt in 4 (1.6%). Mayor procedure-related complications (advanced AV block, tamponade, device embolization, air embolism) occurred in 13 cases (5.2%), and minor complication (1st or 2nd degree AV block, vascular access complications) in 34 (13.7%).
Conclusions: No persistent 3th degree AV block, permanent sequelae, surgical device removal or deaths were recorded. Systematic transcatheter OSASD closure with the Amplatzer device is safe and efficient. Based on our results all patients with significant OSASD could benefit from a transcatheter attempt with intention to close.
- © 2011 by American Heart Association, Inc.