Alban-Elouen Baruteau1, Jérôme Petit2, Virginie Lambert2, Marielle Gouton2, Dominique Piot2, Philippe Brenot2, Claude-Yves Angel2, Lucile Houyel2, Emmanuel Le Bret2, Régine Roussin2, Mohamedou Ly2, André Capderou2, Emre Belli2. 1. From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.). a.baruteau@gmail.com. 2. From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l'Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche Médicale (INSERM) 999, Marie Lannelongue Hospital, Paris, France (V.L., A.C.).
Abstract
BACKGROUND: Data are needed on the safety and efficacy of device closure of large atrial septal defects. METHODS AND RESULTS: Between 1998 and 2013, 336 patients (161 children <15 years) with large, isolated, secundum atrial septal defects (balloon-stretched diameter ≥34 mm in adults or echocardiographic diameter >15 mm/m(2) in children) were managed using the Amplatzer device, at the Marie Lannelongue Hospital. Transthoracic echocardiographic guidance was used starting in 2005 (n=219; 65.2%). Balloon-stretched diameter was >40 mm in 36 adults; mean values were 37.6±3.3 mm in other adults and 26.3±6.3 mm/m(2) in children. Amplatzer closure was successful in 311 (92.6%; 95% confidence interval, 89%-95%) patients. Superior and posterior rim deficiencies were more common in failed than in successful procedures (superior, 24.0% versus 4.8%; P=0.002; and posterior, 32.0% versus 4.2%; P<0.001). Device migration occurred in 4 adults (2 cases each of surgical and transcatheter retrieval); in the 21 remaining failures, the device was unreleased and withdrawn. After a median follow-up of 10.0 years (2.5-17 years), all patients were alive with no history of late complications. CONCLUSIONS: Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction. Long-term follow-up showed no deaths or major late complications in our population of 311 patients.
BACKGROUND: Data are needed on the safety and efficacy of device closure of large atrial septal defects. METHODS AND RESULTS: Between 1998 and 2013, 336 patients (161 children <15 years) with large, isolated, secundum atrial septal defects (balloon-stretched diameter ≥34 mm in adults or echocardiographic diameter >15 mm/m(2) in children) were managed using the Amplatzer device, at the Marie Lannelongue Hospital. Transthoracic echocardiographic guidance was used starting in 2005 (n=219; 65.2%). Balloon-stretched diameter was >40 mm in 36 adults; mean values were 37.6±3.3 mm in other adults and 26.3±6.3 mm/m(2) in children. Amplatzer closure was successful in 311 (92.6%; 95% confidence interval, 89%-95%) patients. Superior and posterior rim deficiencies were more common in failed than in successful procedures (superior, 24.0% versus 4.8%; P=0.002; and posterior, 32.0% versus 4.2%; P<0.001). Device migration occurred in 4 adults (2 cases each of surgical and transcatheter retrieval); in the 21 remaining failures, the device was unreleased and withdrawn. After a median follow-up of 10.0 years (2.5-17 years), all patients were alive with no history of late complications. CONCLUSIONS: Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction. Long-term follow-up showed no deaths or major late complications in our population of 311 patients.
Authors: Stefana Maria Moisa; Alexandru Burlacu; Crischentian Brinza; Elena Țarcă; Lăcrămioara Ionela Butnariu; Laura Mihaela Trandafir Journal: Diagnostics (Basel) Date: 2022-05-10
Authors: Michael L O'Byrne; Matthew J Gillespie; Kevin F Kennedy; Yoav Dori; Jonathan J Rome; Andrew C Glatz Journal: Catheter Cardiovasc Interv Date: 2016-05-18 Impact factor: 2.692