INTERMEDIATE AND LONG TERM OUTCOME OF PATIENTS AFTER DEVICE CLOSURE OF ASD WITH SPECIAL REFERENCE TO COMPLICATIONS

Authors

  • Tehmina Kazmi
  • Masood Sadiq
  • Asif -ur- Rehman
  • Najam Hyder
  • Farhan Latif

Abstract

Background: Device closure of Secundum atrial septal defect (ASD) is an accepted mode of treatment inselected patients with a suitable defect. The major initial concern over the long term outcome has beenerosions and more recently development of aortic regurgitation. Objective was to assess the intermediateand long term outcome of patients with device closure of ASD with special reference to complications.Methods: Two hundred and four patients with significant Secundum ASD, 16 months to 55 years(median 8 years) were considered for transcatheter closure with the Amplatzer septal occluder fromOctober 1999 to April 2009 with follow up examinations at 1, 3, 6, and 12 months and thereafter at yearlyinterval. Results: Device closure of ASD was done successfully in 202/204 patients. The immediate (first24-hour) major complications included device embolization (n=4), pericardial effusion (n=1) and 2:1 heartblock (n=1). At a mean follow up of 4.9 years (90 days to 9.6 years, median 5.3 years) complete closurewas documented in all patients. Two patients (1%) had developed mild aortic regurgitation. Atrialfibrillation occurred in 3 adult patients (1.5%) at a mean of 2 weeks post procedure with completerecovery within 6 months. There were no late embolizations, erosions or thromboembolic events on longterm follow up. Conclusions: Device closure of Secundum ASD using Amplatzer septal occluder is safeand effective in intermediate and long term follow up with extremely low mortality rate. The risk ofdevelopment of aortic regurgitation or atrial fibrillation is also very low.Keywords: Atrial septal defect, Device closure, Cardiac catheterisation, Complications

References

Dugal JS, Jetly V, Sing C, Datta SK, Sabharwal JS, Sofat S.

Amplatzer Device closure of Atrial Septal Defect and patent

Ductus Arteriosus. Initial Experience MJAFI 2003;59:218–22.

Berger F, Ewert P, Bjornstad PG, Dähnert I, Krings G, BrillaAustenat I, et al. Transcatheter closure as standard treatment

for most interatrial defects: experience in 200 patients treated

with the Amplatzer septal occluder. Cardiol Young

;9:468–73.

Chessa M, Carminati M, Butera G, Bini RM, Drago M, Rosti

L, et al. Early and late complications associated with

transcatheter occlusion of Secundum atrial septal defect. J Am

Coll Cardiol 2002;39:1061–5.

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.

Schoen SP, Boscheri A, Lange SA, Braun MU, Fuhrmann J,

Kappert U, Strasser RH. Incidence of aortic valve regurgitation

and outcome after percutaneous closure of atrial septal defects

and patent foramen ovale. Interventional cardiology. Heart

;94:844–7.

Sadiq M, Akram Z, Butt M. Transcatheter occlusion of

Secundum atrial septal defects with Amplatzer Septal

Occluder–initial experience. Pak J Cardiol 2001;12:61–6.

Amin Z. Transcatheter closure of secundum atrial septal

defects. Catheter Cardiovasc Interv 2006;68:778–87.

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

;45:1213–8.

Fischer G, Stieh J, Uebing A, Hoffmann U, Morf G, Kramer H.

Experience with transcatheter closure of Secundum atrial septal

defects using the Amplatzer septal occluder: a single centre

study in 236 consecutive patients. Heart 2003;89:199–204.

Dalvi B. Balloon assisted technique for closure of large atrial

septal defects. Images Paediatr Cardiol 2008;37:5–9.

Raghuram R A, Krishnan R, Kumar S, Balamurugan K.

Complications in atrial septal defect device closure. Catheter

Cardiovas Interv 2004;63:496–502.

Rao PS, Sideris EB, Hausdorf G, Rey C, Lloyd TR, Beekman

RH, et al. International experience with Secundum atrial septal

defect occlusion by the buttoned device. Am Heart J

;128:1022–35.

Worms AM, Rey C, Bourlon F, Losay J, Marcon F, Godart F,

et al. Experience francaise de la fermeture des communications

interauruculaires de type ostium secundum par la prothese

boutonnee de Sideris. Arch Mal Coeur Vaiss 1996;89:509–15.

Krumsdorf U, Ostermayer S, Billinger K, Trepels T, Zadan

E, Horvath K, et al. Incidence and clinical course of thrombus

formation on atrial septal defect and patient foramen ovale

closure devices in 1,000 consecutive patients. J Am Coll

Cardiol 2004;43:302–5.

Scholtz W, Jategaonkar S, Faber L. Unusual Complication

With Transcatheter Closure of an Atrial Septal Defect

Prevented by Adequate Imaging. Images in Cardiovascular

medicine. Circulation 2008;117:181–3.

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Published

2009-09-01

Issue

Vol. 21 No. 3 (2009): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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