Ten-year experience with transcatheter closure of secundum atrial septal defects

Aim: To present the ten-year experience with transcatheter closure of secundum atrial septal defects (ASD II) using the Amplatzer septal occluder. Methods: From 17 November 1997, to the end of September 2007, 486 patients aged 3.2-77 years (mean 42), 23.6% male, were scheduled for transcatheter closure of ASD II. Cardiac catheterisation, defect balloon sizing and transoesophageal echocardiography were performed under general anaesthesia. Eighteen (3.7%) patients were excluded because of anatomy of the defect unsuitable for transcatheter closure. The remaining 468 patients underwent attempted closure of ASD II. Results: In 18 (3.8%) patients implantation was unsuccessful (in three of them - 0.6%, the occluder embolized). Four hundred and fifty patients underwent successful device implantation (96.2% success). The defect was central in 190 (42%) patients and antero-superior in 260 (58%) patients with partial (: 5 mm) or complete absence of aortic rim. Twenty-four patients had multiple defects and 81 patients had a thin, floppy aneurysmal septum. The defects measured 4-36 mm (18 +/- 5.2) on echocardiography and balloon sized 6-36 mm (21 +/- 8). Devices of 6-40 mm (24 +/- 7.1) (diameter of the central connecting waist) were implanted. Three patients had periprocedural tamponade requiring surgical intervention. Patients were followed for one month (all of them), 6 months (400/450) and 12 months (300/450). One hundred and ninety-five patients were followed for more than 5 years. Complete closure was achieved in 96.9% of patients, with trivial or small residual shunts related to insignificant additional defects in the remaining patients. Among 13.5% (22 patients) of the first 163 patients treated only with aspirin postprocedurally, transient neurological symptoms were observed within 6 months after device implantation. The symptoms were not observed after addition of thienopyridine to the postprocedural protocol. Conclusion: Transvenous closure of secundum atrial septal defects with the Amplatzer septal occluder is safe and effective as shown during up-to 10 years follow-up. Moderate and large defects with complex anatomy can be closed with almost 100% early complete occlusion rate. Major complications (periprocedural implant embolization or cardiac tamponade) are rare (0.6% each). Thienopyridine with aspirin is required within the 6-month postimplantation period.