PERCUTANEOUS CLOSURE OF SECUNDUM ATRIAL SEPTAL DEFECTS WITH THE AMPLATZER OCCLUDER: EARLY CLINICAL EXPERIENCE AND ECHOCARDIOGRAPHIC FOLLOW-UP.

P.C. Hayes,*  D.W. Muller, R.P. Kelly, D.W. Baron, P.R. Roy, M.P. Feneley.

Cardiology Department, St Vincent's Hospital, Darlinghurst, NSW.

OBJECTIVE:  To evaluate the efficacy and safety of percutaneous closure of secundum atrial septal defects (ASD) in adults with the Amplatzer occluder. 

METHOD AND RESULTS:  Between October 1998 and November 1999, percutaneous ASD closure was attempted in 27 patients.  All procedures were performed under transoesophageal echocardiographic (TOE) and fluoroscopic guidance. he mean ASD diameter was 16.8±6.1(6.5-30) mm on TOE.  The mean occluder size was 23.9±6.3(14-38) mm. Echocardiographic or catheter-derived pulmonary artery systolic pressure exceeded 35 mmHg in 8 of 25 pts examined (32%).  Devices were deployed successfully in 25 pts (93%).  The procedure was abandoned in 2 pts after 1 or more unsuccessful attempts.  There were no episodes of device embolism.  Mean procedure time was 80.2±20.2(42-120) mins.  Mean fluoroscopy time was 13.9±10.7(4.8-54.3) mins.  Average post-procedural length of stay was 1.96 (1-5) days.  Complications included: tamponade drained percutaneously in one; reversible jaw subluxation in one and dental trauma in two.  At 10-12 weeks follow up, 3 pts have a residual left-to-right shunt < 1.5:1.  Right ventricular (RV) dilatation was present in all patients at baseline. Echocardiographic follow-up in 16 pts at 3 months showed a significant reduction in RV size from 36.6±7.7 to 30.6±6.2mm (p<0.002).  Intermittent atrial fibrillation or flutter was present in 6 pts pre-closure, and the frequency of episodes decreased in 3 and remained unchanged in 3 post-closure.  New atrial fibrillation or flutter was documented in 3 pts following device placement, and persists in one patient.  There were no documented cases of endocarditis or thromboembolism in 215 patient-months of follow up.

CONCLUSIONS: Percutaneous ASD closure with the Amplatzer occluder is effective and can be performed with low morbidity.