Amplatzer device closure of atrial septal defects in mature adults: analysis of 76 cases.

Ostium secundum atrial septal defects (ASDs) have been successfully closed surgically for over 30 years. The concept of percutaneous closure of such defects was proposed in the 1970s. In 1997, the self expanding Amplatzer nitinol prosthesis was first used in animals, with good results. Human studies soon followed and percutaneous closure of atrial septal defects is now standard treatment in the paediatric population. In exclusively adult populations there remains a relative lack of published data and only one series of any size.1 Adult patients with symptomatic atrial septal defects underwent transthoracic and transoesophageal echocardiography to assess defect location, size, and number, associated anomalies, and a more detailed assessment of the septal anatomy (particularly if aneurysmal) with respect to the inferior and superior rims. In the last five years, the waist diameter of the largest available device has gradually increased from 34 mm to 40 mm. The largest unstretched defect diameter on colour flow mapping likely to allow accommodation of a device has therefore risen from 24 mm to 30 mm during the same period. All procedures were done under general anaesthesia with transeoeophageal echocardiography and fluoroscopy. Two sheaths (7 and 11 French) were introduced into the right femoral vein. The pulmonary to systemic shunt (Qp:Qs) was calculated. A multipurpose catheter was used to cross the ASD and was positioned in the left upper pulmonary vein. Intravenous heparin 5000 iu was given. The defect was sized with a 24 mm or 34 mm highly compliant sizing balloon. An Amplatzer ASD closure device corresponding to the stretched ASD diameter was then taken and de-aired under warm saline. An 8, 10, or 12 French delivery sheath was introduced according to defect size. The ASD closure device was withdrawn into the short connector sheath under saline and was introduced into the delivery sheath …