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. 1999 Sep;82(3):300–306. doi: 10.1136/hrt.82.3.300

Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience

K Chan 1, M Godman 1, K Walsh 1, N Wilson 1, A Redington 1, J Gibbs 1
PMCID: PMC1729188  PMID: 10455079

Abstract

OBJECTIVE—To review the safety and efficacy of the Amplatzer septal occluder for transcatheter closure of interatrial communications (atrial septal defects (ASD), fenestrated Fontan (FF), patent foramen ovale (PFO)).
DESIGN—Prospective study following a common protocol for patient selection and technique of deployment in all participating centres.
SETTING—Multicentre study representing total United Kingdom experience.
PATIENTS—First 100 consecutive patients in whom an Amplatzer septal occluder was used to close a clinically significant ASD or interatrial communication.
INTERVENTIONS—All procedures performed under general anaesthesia with transoesophageal echocardiographic guidance. Interatrial communications were assessed by transoesophageal echocardiography with reference to size, position in the interatrial septum, proximity to surrounding structures, and adequacy of septal rim. Stretched diameter of the interatrial communications was determined by balloon sizing. Device selection was based on and matched to the stretched diameter of the communication.
MAIN OUTCOME MEASURES—Success defined as deployment of device in a stable position to occlude the interatrial communication without inducing functional abnormality or anatomical obstruction. Occlusion status determined by transoesophageal echocardiography during procedure and by transthoracic echocardiography on follow up. Clinical status and occlusion rates assessed at 24 hours, one month, and three months.
RESULTS—101 procedures were performed in 100 patients (86 ASD, 7 FF, 7 PFO), age 1.7 to 64.3 years (mean (SD), 13.3 (13.9)), weight 9.2 to 100.0 kg (mean 32.5 (23.5)). Procedure time ranged from 30 to 180 minutes (mean 92.4 (29.0)) and fluoroscopy time from 6.0 to 49.0 minutes (mean 16.1 (8.0)). There were seven failures, all occurring in patients with ASD, and one embolisation requiring surgical removal. Immediate total occlusion rate was 20.4%, rising to 84.9% after 24 hours. Total occlusion rates at the one and three month follow up were 92.5% and 98.9%, respectively. Complications were: transient ST elevation (1), transient atrioventricular block (1), presumed deep vein thrombosis (1), presumed transient ischaemic attack (1).
CONCLUSIONS—It appears feasible to close interatrial communications and atrial septal defects up to 26 mm stretched diameter safely with the Amplatzer septal occluder. Short term results confirm an early high occlusion rate with no major complications. Careful selection of cases based on the echocardiographic morphology of the ASD and accurate assessment of their stretched diameter is of utmost importance. Further experience with the larger devices and longer term results are required before a firm conclusion regarding its use can be made.


Keywords: interatrial communications; atrial septal defect; Amplatzer septal occluder; congenital heart defects

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Figure 1  .

Figure 1  

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Right atrial and left atrial aspect of the Amplatzer septal occluder.

Figure 2  .

Figure 2  

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(A) Right upper pulmonary vein angiogram in four chamber view showing atrial septal defect with "septal aneurysm." (B) Four chamber view showing Amplatzer septal occluder in place. (C) Venous phase following pulmonary angiography in four chamber view after device deployment showing no residual leak. LA, left atrium; RA, right atrium; RUPV, right upper pulmonary vein. Black arrow, atrial septal defect; white arrow, septal occluder.

Figure 3  .

Figure 3  

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Transoesophageal echocardiogram in transverse plane showing atrial septal defect before occlusion (A) and after occlusion by the Amplatzer septal occluder (B). ASD, atrial septal defect; LA, left atrium; RA, right atrium; SVC, superior vena cava. White arrow, septal occluder.

Figure 4  .

Figure 4  

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Transoesophageal echocardiogram in sagittal view showing atrial septal defect in relation to superior vena cava before occlusion (A) and after occlusion by the Amplatzer septal occluder (B). ASD, atrial septal defect; LA, left atrium; RA, right atrium; SVC, superior vena cava. White arrow, septal occluder.

Figure 5  .

Figure 5  

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Frequency distribution of devices implanted by size.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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