Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

Year 2012, Volume: 39 Issue: 1, 97 - 101, 01.03.2012

Oktay Ergene Cem Nazlı Uğur Kocabaş Hamza Duygu Nihan Kahya Eren Zehra İlke Akyıldız Ali Hikmet Kırdök Rida Berilgen

https://doi.org/10.5798/diclemedj.0921.2012.01.0103

Abstract

Objectives: This study was aimed to evaluate our clinical experiences and investigate results of percutaneous clo-sure of secundum atrial septal defects (ASD) in our clinic. Results: We retrospectively included 70 patients (19 male, 51 female) undergoing percutaneous ASD closure proce-dure with mean age of 36±14.8 (17-75) in our clinic between March 2008 and January 2010. Defect diameter meas-ured by transesophageal echocardiography was 19.7±6.3 mm (6-32 mm). Device size used for percutaneous closure of ASD was 23.7±6.2 (12-36). Devices used for percutaneous closure were nitinol-based devices including Amplatzer (64.7%), Cardiofix (26.7%) and biodegredable BioStar (8.6%). The percutaneous closure procedure was successful at 68 of 70 (97%) patients. In 2 patients procedure failed. Failure reason was device embolization in one patient and device strut fracture in other; so these 2 patients referred to surgery. During follow up 2 more patients also referred to surgery because of device embolization in first day control. In 3 patients (4.2%) supraventricular arrythmias that are converted to sinus by cardioversion are observed. Mean follow up interval was 18.6±9.6 months (1-44) and during this period peripheral vascular complications, cerebrovascular accidents, thrombus on devices, device erosion or death is not observed. Conclusion: Percutaneous closure of secundum ASD which started to replace surgical treatment of ASD in last dec-ades is safe and effective method in short to mid-term period. However because of potentially serious complication risks it should be performed in special centers by operators who are experienced in treating structural heart diseases.

Keywords

Atrial septal defect, percutaneous closure, clinical outcome

Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

Abstract

Amaç: Bu çalışmada, kliniğimizde perkütan yolla atrial septal defekt (ASD) kapatılması işlemi uygulanan hastalara ait klinik deneyimimizin ve sonuçlarının değerlendirilmesi amaçlanmıştır. Bulgular: Çalışmaya kliniğimizde, Mart 2008-Ocak 2010 tarihleri arasında perkütan yolla ASD kapatılması işlemi uy-gulanan ortalama yaşı 36±14,8 olan (17-75) yıl olan 70 hasta (19 erkek, 51 kadın) retrospektif olarak alındı. Hastala-rın transözofajial ekokardiyografi ölçümlerinde ASD çapı 19,7±6,3 mm (6-32 mm) olarak ölçüldü. Perkütan kapatma-da kullanılan cihaz çapları 23,7±6,2 (12-36) olarak saptandı. ASD kapatma cihazı olarak nitinol bazlı cihazlardan Amplatzer %64,7, Cardiofix %26,7 oranında ve biodegredable BioStar %8,6 oranında kullanıldı. Yetmiş hastadan 68\'inde (%97) işlem başarılı oldu. Bir hastada işlem esnasında cihaz embolisi, 1 hastada ise cihazda strut kırığı ol-ması nedeniyle hastalar cerrahiye verildi. Takipte 2 hastada 1. gün kontrolünde cihaz embolizasyonu saptandı. Üç hastada (%4,2) kardiyoversiyon ile sinus ritmine çevrilen supraventriküler aritmi izlendi. Hastalar ortalama 18,6±9,6 ay (1 ay- 44 ay) boyunca izlendi. Takipte hastalarda cihaz üzerinde thrombüs, cihaz erozyonu, periferik vasküler komplikasyon, serebro vasküler olay veya ölüm izlenmedi. Sonuç: Sekundum ASD\'lerin perkütan kapatılması son yıllarda cerrahinin yerini almaya başlayan kısa ve orta vadede güvenli, etkin bir tedavi şeklidir. İşlemin potansiyel ciddi olabilecek komplikasyonları nedeniyle yapısal kalp hastalıkla-rının tedavisinde uzmanlaşmış; tecrübeli merkezlerde yapılması hususuna dikkat edilmelidir.

Keywords

Atrial septal defekt, perkütan kapatma, klinik sonuçlar

References

• Kim MS, Klein AJ, Carroll JD. Transcatheter closure of intra- cardiac defects in adults. J Interv Cardiol 2007 ;20(6):524- 45.
• Baumgartner H, Bonhoeffer P, De Groot NM, et al; Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC). ESC Guidelines for the management of grown-up con- genital heart disease (newversion 2010).Eur Heart J 2010 ;31(23):2915-57.
• Fischer G, Stieh J, Uebing A, Hoffmann U, Morf G, Kramer HH. Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart 2003;89(2):199 -204.
• Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 2002;39(11):1836-44.
• Dhillon R, Thanopoulos B, Tsaousis G, Triposkiadis F, Kyriakidis M, Redington A. Transcatheter closure of atrial septal defects in adults with the Amplatzer septal occluder. Heart 1999;82(5):559-62.
• Butera G, Carminati M, Chessa M, et al. Percutaneous ver- sus surgical closure of secundum atrial septal defect: com- parison of early results and complications. Am Heart J 2006 ;151(1):228-34.
• Amanullah MM, Siddiqui MT, Khan MZ, Atiq MA , Sur- gical rescue of embolized amplatzer devices. J Card Surg 2011;26(3):254-8.
• Spies C, Khandelwal A, Timmermanns I, Schräder R. In- cidence of atrial fibrillation following transcatheter clo- sure of atrial septal defects in adults. Am J Cardiol 2008 1;102(7):902-6.
• Johnson JN, Marquardt ML, Ackerman MJ, et al. Electro- cardiographic changes and arrhythmias following percuta- neous atrial septal defect and patent foramen ovale device closure. Catheter Cardiovasc Interv 2011; 1;78(2):254-61.
• Vecht JA, Saso S, Rao C, et al. Atrial septal defect closure is associated with a reduced prevalence of atrialtachyarrhyth- mia in the short to medium term: a systematic review and meta-analysis. Heart 2010 ;96(22):1789-97.
• Yared K, Baggish AL, Solis J, et al. Echocardiographic as- sessment of percutaneous patent foramen ovale and atrial septal defect closure complications. Circ Cardiovasc Imag- ing 2009 ;2(2):141-9.
• Taaffe M, Fischer E, Baranowski A, et al. Comparison of three patent foramen ovale closure devices in a randomized trial (Amplatzer versus CardioSEAL-STARflex versus He- lex occluder). Am J Cardiol 2008 1;101(9):1353-8.
• Fagan T, Dreher D, Cutright W, Jacobson J, Latson L. Frac- ture of the GORE HELEX septal occluder: associated fac- tors and clinical outcomes Catheter Cardiovasc Interv 2009 1;73(7):941-8.
• Butera G, Romagnoli E, Saliba Z, et al. Percutaneous clo- sure of multiple defects of the atrial septum: procedural re- sults and long-term follow-up. Catheter Cardiovasc Interv 2010 1;76(1):121-8.
• Majunke N, Sievert H, ASD/PFO devices: what is in the pipeline? J Interv Cardiol. 2007 ;20(6):517-23.
• Ilkay E, Kaçmaz F, Ozeke O, et al. The efficiency and safety of percutaneous closure of secundum atrial septal defects with the Occlutech Figulla device: initial clinical experi- ence. Turk Kardiyol Dern Ars 2010 ;38(3):189-93.
• Yüce M, Ozer O, Cakıcı M, Sarı I, Davutoğlu V, Doğan A, Alıcı H, Yavuz F, Aksoy M. Closure of secundum atrial sep- tal defects by the Amplatzer occluder device Turk Kardiyol Dern Ars 2011;39(1):35-40.
• Kaya MG, Ozdoğru I, Baykan A, et al. Transcatheter clo- sure of secundum atrial septal defects using the Amplatzer septal occluder in adult patients: our first clinical experi- ences. Turk Kardiyol Dern Ars 2008 ;36(5):287-93.
• Opotowsky AR, Landzberg MJ, Kimmel SE, Webb GD. Percutaneous closure of patent foramen ovale and atrial septal defect in adults: the impact of clinical variables and hospital procedure volume on in-hospital adverse events. Am Heart J 2009;157(5):867-74.