Transcatheter closure of atrial communications using the Amplatzer™ Septal Occluder

Certain types of atrial septal defects (ASDs) are amenable for transcatheter closure using various investigational devices. The use of the clamshell or buttoned devices is accompanied with a high incidence of residual shunt. The experience of ASD closure using the Amplatzer(TM) Septal Occluder (ASO) is limited. Therefore, the purpose of this this article is to discuss the protocol of closure and report on the acute results using this device. Nineteen patients (17 ASD/2 fenestrated Fontan [FF]) underwent an attempt at catheter closure of their defects at a median age of 13.3 years (range 5.5-67.4 years) and a median weight of 49 kg (range 18-94 kgl using the ASO. The median ASI) diameter measured by transesophageal echocardiography (TEE) was 12 mm (range 6-23.8 mm) and the median defect balloon stretched diameter was 17 mm (range 6-31 mm). All ASD patients had right atrial and ventricular volume overload with a mean +/- SD Qp/Qs of 2.4 +/- 0.9. A 7 to 8Fr catheter was used for delivery of the device in all patients. The device was placed correctly in all but one patient. There were immediate and complete closures (C) in 13 of 18 patients; 3 patients had trivial residual shunts (TS), and 2 patients had small residual shunts (SS). In the two patients with FF, oxygen saturation improved from 85% to 95% and 88% to 96%, respectively. One patient received two devices for two separate defects. The median fluoroscopy time was 15.5 minutes (range 7.4-33.4 minutes), and the median total procedural time was 78 minutes (range 52-180 minutes). There was one episode of device embolization in one patient. The device was successfully retrieved and 2 months later a second closure was performed successfully. Na other complications were encountered during or after the procedure. Follow-up was performed using transthoracic echocardiography (TTE) at 2 day and I month and by TEE at 3 months. At day 1, there was C of the defect in 15 of 19 patients and 4 had TS; 18 patients completed 1-month follow-up, 16 of 18 had C and 2 patients had TS. Eleven patients completed 3-month follow-up, all with C. So far there have been no episodes of endocarditis, thromboembolism, or wire fracture. We conclude that the use of the new ASO is safe and effective in complete closure of atrial communications up to 23.8 mm in diameter.