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Impact of modified techniques of transcatheter closure in large atrial septal defects (⩾30 mm) with anatomic complexities

Published online by Cambridge University Press:  23 July 2018

Ajith Ananthakrishna Pillai Open the ORCID record for Ajith Ananthakrishna Pillai [Opens in a new window] ,
Amarnath Upadhyay ,
Saranya Gousy  and
Amit Handa
Ajith Ananthakrishna Pillai*
Affiliation:
Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
Amarnath Upadhyay
Affiliation:
Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
Saranya Gousy
Affiliation:
Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
Amit Handa
Affiliation:
Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
*
Author for correspondence: A. A. Pillai, Additional Professor, Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry 605006, India. Tel: +91 9488828946; Fax: +91 4137199; E-mail: ajithanantha@yahoo.com
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Abstract

Objective

The outcome of transcatheter closure in ostium secundum atrial septal defects is determined by the morphology of the defects. Modified techniques such as balloon assistance, pulmonary vein deployment, left atrial roof technique, and so on are used for circumventing the anatomic complexities and increasing the success rates.

Methods

We planned a prospective study looking at the outcomes of transcatheter closure in secundum atrial septal defects with modified techniques in different anatomic complexities identified in transoesophageal echocardiography and their association with outcome of transcatheter closure.

Results

Transcatheter closure was successful in 295 out of 346 (82%) patients with modified techniques. Balloon-assisted technique offered a success rate of 87%. The mean defect size was 34.7±2.78 mm (95% confidence interval (CI) 30.67–43.1 mm) with success and 40.16±4.5 mm (95% CI 32.16–44.7) with failure (p = 0.02). The mean total septal length was 38.11±0.63 (95% CI 35.21–40.56 mm) with success and 42.54±0.34 (95% CI 38.79–43.21 mm) with failure. The defect to septal ratios were 0.82 and 0.94 in success and failure groups, respectively (p=0.02). However, the absence of a retro-aortic margin, septal aneurysm, and multiple defects did not affect the success rate. Deficient inferior vena caval margin, deficient posterior margin, and size⩾40 mm had a high risk of failure with transcatheter closure. The odds ratio for procedural failure was 25.3 (4.3–143.8) in patients with malaligned septum, 8.3(1.4–48.5) with deficient inferior vena caval margin, and 4.1(2.5–19) for size⩾40 mm.

Conclusions

The modified techniques for device deployment offer substantial chances of success in transcatheter closure of secundum atrial septal defects with anatomical complexity (82%). Variants such as defect size of⩾40 mm and deficient inferior and posterior margins have high failure rates with a modified technique.

Keywords

Inter-atrial septummorphologyatrial septal defectseptal malalignmentdevice closure
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 10 , October 2018 , pp. 1122 - 1133
Copyright
© Cambridge University Press 2018 

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References

1. Therrien, J, et al. Canadian Cardiovascular Society Consensus Conference 2001 update: recommendations for the management of adults with congenital heart disease part III. Can J Cardiol 2001; 17: 1135–1158.Google Scholar
2. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). J Am Coll Cardiol 2008; 52: e143–e263.Google Scholar
3. Santoro, G, Bigazzi, MC, Lacono, C, et al. Transcatheter closure of complex atrial septal defects: feasibility and mid-term results. J Cardiovasc Med (Hagerstown) 2006; 7: 176–181.Google Scholar
4. Dalvi, BV, Pinto, RJ, Gupta, A. New technique for device closure of large atrial septal defects. Catheter Cardiovasc Interv 2005; 64: 102–107.Google Scholar
5. Amin, Z. Trans catheter closure of secundum atrial septal defects. Catheter Cardiovasc Interv 2006; 68: 778–787.Google Scholar
6. Spies, C, Boosfeld, C, Schrader, R. A modified Cook sheath for closure of a large secundum atrial septal defect. Catheter Cardiovasc Interv 2007; 73: 90–96.Google Scholar
7. Wahab, HA, Bairam, AR, Cao, QL, Hijazi, ZM. Novel technique to prevent prolapse of the Amplatzer septal occluder through large atrial septal defect. Catheter Cardiovasc Interv 2003; 60: 543–545.Google Scholar
8. Varma, C, Benson, LN, Silversides, C, et al. Outcomes and alternative techniques for device closure of the large secundum atrial septal defect. Catheter Cardiovasc Interv 2004; 61: 131–139.Google Scholar
9. 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: 38–44.Google Scholar
10. Akagi, T. Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol 2015; 65: 17–25.Google Scholar
11. McElhinney, DB, Quartermain, MD, Kenny, D, Alboliras, E, Amin, Z. Relative risk factors for cardiac erosion following trans catheter closure of atrial septal defects: a case-control study. Circulation 2016; 133: 1738–1746.Google Scholar
12. Butera, G, Lovin, N, Basile, DP, Carminati, M. Goose-neck snare-assisted transcatheter ASD closure: a safety procedure for large and complex ASDs. Catheter Cardiovasc Interv 2016; 87: 926–930.Google Scholar
13. Pillai, AA, Rangaswami Balasubramanian, V, Selvaraj, R, Saktheeswaran, M, Satheesh, S, Jayaraman, B. Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects. Cardiovasc Diagn Ther 2014; 4: 21–27.Google Scholar
14. Pedra, CA, Pedra, SF, Costa, RN, et al. Mid-term outcomes after percutaneous closure of the secundum atrial septal defect with the figulla-occlutech device. J Interv Cardiol 2016; 29: 208–215.Google Scholar
15. Schwinger, ME, Gindea, AJ, Freedberg, RS, Kronzon, I. The anatomy of the interatrial septum: a trans oesophageal echocardiographic study. Am Heart J 1990; 119: 1401–1405.Google Scholar
16. Sah, SP, Bartakian, S, El-Said, H, Molkara, DP 1, Printz, B 1, Moore, JW. Preprocedural transthoracic echocardiography can predict Amplatzer septal occluder device size for trans catheter atrial septal defect closure. Congenit Heart Dis 2016; 11: 656–662.Google Scholar
17. Ostovan, MA, Kojuri, J, Dehghani, P, Razazi, V, Moarref, A. Device closure in adults with atrial septal defect in Shiraz, a single center registry. J Cardiovasc Thorac Res 2016; 8: 40–42.Google Scholar
18. Haas, NA, Soetemann, DB, Ates, I, et al. Closure of secundum atrial septal defects by using the occlutech occluder devices in more than 1300 patients: the IRFACODE project: a retrospective case series. Catheter Cardiovasc Interv 2016; 88: 571–581.Google Scholar