Clinical application of Amplatzer septal occluder device for transcatheter closure of secundum atrial septal defect: a report of 60 cases

Objective To evaluate the efficiency of transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer occluder device Methods Sixty patients with ASD were treated by transcatheter closure of ASD with Amplatzer occluder device. The mean age of patients was 31 00±12 31 years (ranged from 5 to 53 years) and the mean weight was 51 19±12 12 kg (ranged from 18 to 79 kg). The mean diameter of ASD was 18 14±6 18 mm (ranged from 6 to 28 mm) shown by transesophageal echocardiography (TEE) before interventions. Three cases had double ASD. Each case was treated with Amplatzer occluder device through the percutaneous procedure under fluoroscopy and TEE. After the procedure, TEE were performed immediately to find whether there any residual shunt remained. Transthoracic echocardiography (TTE), ECG and X ray examination were done 24 hour, 1 month, 3 month and 1 year after the procedure to evaluate the efficiency. Results The mean balloon stretched diameter of the ASDs was 21 42±6 11 mm (ranged from 8 to 32 mm). The mean diameter of the occluder selected was 23 12±5 72 mm (ranged from 10 to 34 mm). The success rate of placement of Amplatzer occluder was 100%. No complications occurred during the procedure, and no one needed for emergecy surgery. For each of the 3 cases with double ASD, a larger device was used for closing both of the bigger ASD and the smaller one with good results. Trivial to small residual shunts were found in 10 cases (16 7%) immediately after the procedure, in 8 cases (13 3%, including 3 cases with multiple ASD) 24 hour, and in 6 cases (10%, including 1 case with multiple ASD) 1 month after the procedure. A 3 month follow up was completed in forty patients and no residual shunt was found except in 1 (2 5%). Ten patients carried out 1 year follow up and no residual shunt and recanalization were found. X ray examination showed that both pulmonary vascularity and heart size were improved. Conclusions Transcatheter closure of secundum ASD using Amplatzer septal occluder device is an efficient nonsurgical method for patients of any age group. The operation is simple and safe with a high success rate of placement and a good occlusion effect. The long term follow up remains to be studied.