TRANSCATHETER ATRIAL SEPTAL DEFECT (ASD) CLOSURE IN CHILDREN & ADULTS WITH THE AMPLATZER ASD OCCLUDER. N.J.Wilson*, T.L.Gentles, C.O'Donnell, C.Occleshaw, A.L. Calder, J.Skinner, J.M. Neutze.
Paediatric Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
From 12/97 28 pts, 12 children and 16 adults, preselected by echocardiography, have undergone transoesophageal echocardiography and cardaic catheterisation with a view to proceed to transcatheter ASD closure. Indications for closure were secundum ASD with right ventricular volume overload in 25 pts, and a patent foramen ovale with presumed paradoxical embolism in 3. In 3 pts transcatheter closure was not attempted due to large size (1), PAPVD (1), deficient right upper pulmonary vein rim (1). An Amplatzer septal occluder was deployed in 23 pts and a CardioSeal device in 2. The mean size of the ASDs by echo was 13.7 ± 3.1 mm, and the ballooned stretched size of the defect 21.1 ± 5.5mm, 10 defects were > 22mm. The defects were fenestrated in 6 pts. In one pt a 3Omm device would not open fully so a device was not deployed. Procedure time was 51-165 min, median 90 min, median fluoroscopy time 21 min. All but 2 pts were discharged the next day. There was one significant complication in an adult who developed a sciatic nerve haematoma and subsequent palsy related to femoral vein puncture. Elective surgical removal of a 28mm device was undertaken in a 6 year old child because the device appeared too large relative to the atrial septum. At discharge 16/23 (70%) of ASDs were completely closed, at 1 month 14/18 (78%) were closed and at 3 months 12/15 (80%) were closed. RV volume had normalised in all cases, and all residual leaks were < 2mm.
Conclusions. Most patients with small or moderate central secundum ASDs can have successful transcatheter ASD closure with high efficacy and low morbidity. The largest Amplatzer ASD occluder is 34mm but our experience suggests 22-24mm should be the upper limit for children < 1 0 years.
