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Transcatheter closure of large secundum atrial septal defects using the 40 mm Amplatzer septal occluder: Results of an international registry
Author(s) -
Lopez Keila,
Dalvi Bharat V.,
Balzer David,
Bass John L.,
Momenah Tarek,
Cao QiLing,
Hijazi Ziyad M.
Publication year - 2005
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20468
Subject(s) - medicine , septum secundum , fluoroscopy , shunt (medical) , embolization , perforation , intracardiac injection , doppler echocardiography , balloon , surgery , heart septal defect , cardiac catheterization , cardiology , diastole , materials science , punching , blood pressure , metallurgy
Little is known about the efficacy and safety of the 40 mm Amplatzer septal occluder (ASO). Thirty‐three patients (22 female, 11 male) with a large secundum atrial septal defect (ASD) underwent attempted device closure using the 40 mm ASO at a median age of 40 years (range, 14–81 years) and median weight of 65 kg (range, 48–98 kg). The median size of the ASD measured on 2D transesophageal echocardiography (27 patients) or intracardiac echocardiography (6 patients) was 30.5 mm (range, 24–39 mm) and the median balloon‐stretched diameter was 37.7 mm (range, 32–43.7 mm). The median Qp:Qs ratio was 3.2:1 (range, 1.4–6.2). The attempt was unsuccessful in five patients; two had device embolization and one had left atrial wall perforation due to the sheath; all three required emergent surgery. The attempt was successful in the 28 remaining patients, resulting in complete immediate closure in 14 and a trivial residual shunt in 14. Fluoroscopy time ranged from 8.6 to 37.8 min (median, 12.2 min). At 24‐hr follow‐up, 2D transthoracic echocardiography with color flow Doppler revealed complete closure in 23 patients, and 5 had a trivial residual shunt. There were no complications encountered in patients who received the device. On follow‐up, all patients are doing well. We conclude that the 40 mm ASO is safe and effective in most patients with a large ASD up to a diameter of 39 mm. However, the use of this device requires careful attention as the procedure may be unsuccessful or the device may embolize. © 2005 Wiley‐Liss, Inc.