Endovascular Closure of Secundum Atrial Septal Defects with Complex Anatomy
According to European guidelines, endovascular closure is the method of choice for defects with favorable anatomy. However, there are no clear criteria for determining favorable anatomy and this issue requires additional investigation. According to literature data, only 24.2% of secundum atrial septal defects (ASDII) have a central location, others have complicated anatomy.
The aim. To analyze the experience of endovascular closure of ASDII with complex anatomy. Materials. In the period from 2003 to 2021, 1732 transesophageal echocardiographies and intracardiac echocardiographieswereperformedinpatientswithASDIIinitiallydiagnosedaccordingtotransthoracicechocardiography, and only 1408 (91.8%) were selected for endovascular closure. Mean age was 19.9±18 years, mean weight was 45±26.68 kg.
Methods. The standard closure technique was primarily used in 100% of cases, and only when it was ineffective, we used modified techniques.
Results. Modified techniques were used in 478 (33.9%) of 1408 patients and were effective in 460 (96.2%) patients with the complex anatomy. Based on previous statement, 460 (32.6%) of 1408 patients (one third of all) had modified techniques utilized and avoided open surgery. In 18 (1.3%) cases, it was impossible to close the defect. The overall technical success of transcatheter closure was 98.7% (1390 patients). Nineteen (1.3%) patients with poor visualization of inferior rim on transesophageal echocardiography had intracardiac echocardiography; in two of them inferior rim was present, others had open surgery. The rate of complications in immediate periprocedural period was 1.9% (27 patients). One death was recorded in the period of introduction of percutaneous interventions in our institution. Mean follow-up period was 5.41±3.28 years. In the follow-up period two complications were observed: 1 case of erosion, 17 (1.9%) cases of new-onset atrial fibrillation.
Conclusion. The majority (90.6%) of ASDII can be closed percutaneously. Modified techniques improve the efficacy of the procedure enabling to close 32.6% of the defects. Safe procedure for the defects with complex anatomy is possible only with surgical and arrhythmological services back-up.
- Bedford DE. The anatomical types of atrial septal defect. Their incidence and clinical diagnosis. Am J Cardiol. 1960;6:568-74. https://doi.org/10.1016/0002-9149(60)90258-7
- Mahmoud H, Nicolescu AM, Filip C, Nicolae G, Duică G, Bălgrădean M, et al. Complex atrial septal defect closure in children. Rom J Morphol Embryol. 2019;60(1):49-57. PubMed PMID: 31263827.
- King TD, Thompson SL, Steiner C, Mills NL. Secundum Atrial Septal Defect. Nonoperative Closure During Cardiac Catheterization. JAMA. 1976;235(23):2506-9. PubMed PMID: 946659.
- Baumgartner H, De Backer J, Babu-Narayan SV, Budts W, Chessa M, Diller GP, et al.; ESC Scientific Document Group. 2020 ESC Guidelines for the management of adult congenital heart disease: The Task Force for the management of adult congenital heart disease of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Adult Congenital Heart Disease (ISACHD). Eur Heart J. 2021;42(6):563-645. https://doi.org/10.1093/eurheartj/ehaa554
- Podnar T, Martanovic P, Gavora P, Masura J. Morphological variations of secundum-type atrial septal defects: feasibility for percutaneous closure using Amplatzer septal occluders. Catheter Cardiovasc Interv. 2001;53(3):386-91. https://doi.org/10.1002/ccd.1187
- Amin Z. Transcatheter closure of secundum atrial septal defects. Catheter Cardiovasc Interv. 2006;68(5):778-87. https://doi.org/10.1002/ccd.20872
- Zinkovsky MF. [Congenital heart disease: a guide]. Vozianov AF, editor. Kyiv: Knyga plus; 2009. Russian.
- Gibbon JH Jr. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 1954;37(3):171-85; passim. PubMed PMID: 13154149.
- Masura J, Gavora P, Formanek A, Hijazi ZM. Transcatheter closure of secundum atrial septal defects using the new self-centering amplatzer septal occluder: initial human experience. Cathet Cardiovasc Diagn. 1997;42(4):388-93. https://doi.org/10.1002/(sici)1097-0304(199712)42:4<388::aid-ccd7>3.0.co;2-7
- Lazoryshynetz VV, Ditkivskyy IO, Truba YaP, Petrov MS, Mazur OA, Perepeka IA. [Tendencies of congenital heart diseases surgical correction: 10 years experience of M. M. Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine]. Journal of the National Academy of Medical Sciences of Ukraine. 2021;27(4):271-8. Ukrainian. https://doi.org/10.37621/JNAMSU-2021-4-6
- Pillai AA, Satheesh S, Pakkirisamy G, Selvaraj R, Jayaraman B. Techniques and outcomes of transcatheter closure of complex atrial septal defects – single center experience. Indian Heart J. 2014;66(1):38-44. https://doi.org/10.1016/j.ihj.2013.12.016
- Faccini A, Butera G. Atrial septal defect (ASD) device trans-catheter closure: limitations. J Thorac Dis. 2018;10(Suppl 24) : S2923-S2930. https://doi.org/10.21037/jtd.2018.07.128
- Ditkivskyy IO, Voloshyn DL, Yermolovych YV, Perepeka IA, Lazoryshynets VV. [Endovascular Closure of Secondary Septal Defect in Children with Low Body Weight]. Ukrainian Journal of Cardiovascular Surgery. 2022;30(4):53-8. Ukrainian. https://doi.org/10.30702/ujcvs/22.30(04)/DV061-5358