Yonsei Med J.  2013 Sep;54(5):1104-1109. 10.3349/ymj.2013.54.5.1104.

Outcome of Transcatheter Closure of Oval Shaped Atrial Septal Defect with Amplatzer Septal Occluder

• Song J
• Lee SY
• Baek JS
• Shim WS
• Choi EY

• KMID: 1793156
• DOI: http://doi.org/10.3349/ymj.2013.54.5.1104

Abstract

PURPOSE
For the successful completion of transcatheter closure of atrial septal defects with the Amplatzer septal occluder, shape of the defects should be considered prior to selecting the device. The purpose of this study is to evaluate the results of a transcatheter closure of oval shaped atrial septal defect.
MATERIALS AND METHODS
From November 2009 until November 2011, cardiac computed tomography was performed on 69 patients who needed a transcatheter closure of atrial septal defect. We defined an oval shaped atrial septal defect as the ratio of the shortest diameter to the longest diameter < or =0.75 measured using computed tomography. A trans-thoracic echocardiogram was performed one day after and six months after.
RESULTS
The transcatheter closure of atrial septal defect was performed successfully in 24 patients in the ovoid group and 45 patients in the circular group. There were no serious complications in both groups and the complete closure rate at 6 months later was 92.3% in the ovoid group and 93.1% in the circular group (p>0.05). The differences between the device size to the longest diameter of the defect and the ratios of the device size to the longest diameter were significantly smaller in the ovoid group (1.8+/-2.8 vs. 3.7+/-2.6 and 1.1+/-0.1 vs. 1.2+/-0.2).
CONCLUSION
Transcatheter closure of an oval shaped atrial septal defect was found to be safe with the smaller Amplatzer septal occluder device when compared with circular atrial septal defects.

Keyword

Congenital heart disease; atrial septal defect; transcatheter intervention; device closure; cardiac computed tomography

MeSH Terms

Echocardiography
Heart Septal Defects, Atrial/pathology/*surgery
Humans
Middle Aged
Postoperative Complications
Republic of Korea
Retrospective Studies
Septal Occluder Device/*adverse effects
Tomography, X-Ray Computed
Treatment Outcome

Figure

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  Fig. 1 The reconstructed en face image from cardiac computed tomography shows the longest diameter (a) and the shortest diameter (b).

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  Fig. 2 (A) The tomographic image shows oval shaped atrial septal defect (arrows). (B) There is a small gap between the waist of the device and the anterior margin of the defect on computed tomographic image of patient C immediately after implantation.

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  Fig. 3 The complete closure rates the next day and 6 months after were not statistically different in both groups (p>0.05).

Reference

1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002; 39:1890–1900.

2. Barratt-Boyes BG, Kirklin JW. Cardiac Surgery. New York: Churchill Livingstone;1993. p. 609–644.

3. Galal MO, Wobst A, Halees Z, Hatle L, Schmaltz AA, Khougeer F, et al. Peri-operative complications following surgical closure of atrial septal defect type II in 232 patients--a baseline study. Eur Heart J. 1994; 15:1381–1384.

4. Masura J, Gavora P, Podnar T. Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders. J Am Coll Cardiol. 2005; 45:505–507.

5. Yew G, Wilson NJ. Transcatheter atrial septal defect closure with the Amplatzer septal occluder: five-year follow-up. Catheter Cardiovasc Interv. 2005; 64:193–196.

6. Johri AM, Witzke C, Solis J, Palacios IF, Inglessis I, Picard MH, et al. Real-time three-dimensional transesophageal echocardiography in patients with secundum atrial septal defects: outcomes following transcatheter closure. J Am Soc Echocardiogr. 2011; 24:431–437.

7. Roberson DA, Cui W, Patel D, Tsang W, Sugeng L, Weinert L, et al. Three-dimensional transesophageal echocardiography of atrial septal defect: a qualitative and quantitative anatomic study. J Am Soc Echocardiogr. 2011; 24:600–610.

8. Knepp MD, Rocchini AP, Lloyd TR, Aiyagari RM. Long-term follow up of secundum atrial septal defect closure with the amplatzer septal occluder. Congenit Heart Dis. 2010; 5:32–37.

9. Acar P. Three-dimensional echocardiography in transcatheter closure of atrial septal defects. Cardiol Young. 2000; 10:484–492.

10. Huang X, Shen J, Huang Y, Zheng Z, Fei H, Hou Y, et al. En face view of atrial septal defect by two-dimensional transthoracic echocardiography: comparison to real-time three-dimensional transesophageal echocardiography. J Am Soc Echocardiogr. 2010; 23:714–721.

11. Ko SF, Liang CD, Yip HK, Huang CC, Ng SH, Huang CF, et al. Amplatzer septal occluder closure of atrial septal defect: evaluation of transthoracic echocardiography, cardiac CT, and transesophageal echocardiography. AJR Am J Roentgenol. 2009; 193:1522–1529.

12. Zanchetta M, Onorato E, Rigatelli G, Pedon L, Zennaro M, Carrozza A, et al. Intracardiac echocardiography-guided transcatheter closure of secundum atrial septal defect: a new efficient device selection method. J Am Coll Cardiol. 2003; 42:1677–1682.

13. Gupta SK, Sivasankaran S, Bijulal S, Tharakan JM, Harikrishnan S, Ajit K. Trans-catheter closure of atrial septal defect: Balloon sizing or no Balloon sizing-single centre experience. Ann Pediatr Cardiol. 2011; 4:28–33.

14. Zanchetta M. On-line intracardiac echocardiography alone for Amplatzer Septal Occluder selection and device deployment in adult patients with atrial septal defect. Int J Cardiol. 2004; 95:61–68.

15. Amin Z, Hijazi ZM, Bass JL, Cheatham JP, Hellenbrand WE, Kleinman 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. Catheter Cardiovasc Interv. 2004; 63:496–502.

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; 45:1213–1218.