CLINICAL STUDY: LEFT VENTRICULAR FUNCTION
Early and late complications associated with transcatheter occlusion of secundum atrial septal defect
Massimo Chessa, MD, PhDa,*,
Mario Carminati, MDa,
Gianfranco Butera, MD, PhDa,
Roberta Margherita Bini, MDa,
Manuela Drago, MDa,
Luca Rosti, MDa,
Alessandro Giamberti, MDa,
Giuseppe Pomè, MDa,
Eduardo Bossone, MD, PhDa and
Alessandro Frigiola, MDa
a Pediatric Cardiology, Istituto Policlinico San Donato, San Donato Milanese, Italy
Manuscript received June 28, 2001;
revised manuscript received December 4, 2001,
accepted December 21, 2001.
* Reprint requests and correspondence: Dr. Massimo Chessa, Pediatric Cardiology, Istituto Policlinico San Donato, Via Morandi, 30, 20097 San Donato Milanese, Italy.
massimo.chessa{at}lycos.com
OBJECTIVES: The goal of this study was to report the early and late complications experienced in atrial septal defect (ASD) transcatheter closure.
BACKGROUND: Atrial septal defect transcatheter occlusion techniques have become an alternative to surgical procedures. A number of different devices are available for transcatheter ASD closure. The type and rate of complications are different for different devices.
METHODS: Between December 1996 and January 2001, 417 patients (mean age: 26.6 ± 19 years) underwent transcatheter occlusion of secundum type ASD. Complications were categorized into major and minor. Two different devices were used: the CardioSEAL/STARFlex in 159 patients and the Amplatzer septal occluder in 258 patients.
RESULTS: Thirty-four patients experienced 36 complications during the hospitalization (8.6%, 95% confidence interval: 6.1% to 11.1%). Ten patients underwent elective surgical repair because of device malposition (three patients) or device embolization (seven patients). Twenty-four patients experienced 25 minor complications: unsatisfactory device position or embolization. Devices were retrieved using a gooseneck snare and/or a basket; 11 patients experienced arrhythmic problems. Other complications were: pericardial effusion, thrombus formation on the left atrial disc, right iliac vein dissection, groin hematoma, hemorrhage in the retropharynx and sizing balloon rupture. Two patients had late complications: peripheral embolization in the left leg one year after implantation of an Amplatzer device and sudden death 1.5 year later.
CONCLUSIONS: Our series of patients with ASD by transcatheter occlusion shows that the procedure is safe and effective in the vast majority of cases. To further reduce the complications rate, the criteria of device selection according to ASD morphology and some technical tips during implantation are discussed.
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Abbreviations and Acronyms
| | CS/SF | | ASD | | atrial septal defect | | ASO | | Amplatzer septal occluder | | CS/SF | | CardioSEAL/STARFlex | | TEE | | transesophageal echocardiography |
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