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Transcatheter closure of atrial septal defect (TCASD), secundum type with inadequate aortic rim is challenging.Our aim was to compare the immediate results of TCASD using Amplatzer septal occluder devices (ASOD) and no sizing balloon between patients with less or no aortic rims and those with adequate aortic rims in terms of success rate, complications and fluoroscopic time.
From November July 2008 to May 2016, the present study was analyzed 488 consecutive patients who underwent TCASD at Central Chest Institute of Thailand. Transesophageal echocardiography revealed 382 patients with adequate aortic rim as group 1 and 106 patients with no or less aortic rims as group 2. TCASD was done under the guidance of intraprocedural transthoracic echocardiography and fluoroscopy. Baseline characteristics, sizes of ASD, sizes of ASOD, mean pulmonary artery pressure pre and post TCASD, Qp/QS before and after TCASD, success rate, complications, fluoroscopic time and procedural time (PT)were analyzes and compared between both groups.
The patients’ characteristics were comparable in both groups, The mean age was 46 yrs. in gr.1 vs. 42 yrs.in gr.2 and the female gender was predominate (81% in gr.1 vs. 87% in gr.2). The mean maximal diameter of ASD secundum determined by pre cath TEE in gr. 1 and gr. 2 were 21.2 ± 5.9 mm. (range 10-34) and 22.4 ± 5.3 mm.(range 12-32) respectively. The mean size of Amplatzer septal occluder device (ASOD) in gr.1 and gr.2 were 28 ±5.7 mm. (range 14-40) and 29 ±5.3 mm. (range 16-40) respectively. The success rate were 97 % in both groups. Major complications were comparable in both groups such as device embolization in 5 patients (1.3%) of gr.1 and 3 patients (2.8%) of gr.2 (p=0.276). Fluoroscopic time was comparablein both groups (gr.1; 11.6±6.6 min. vs gr.2; 11.2±5.3 min., p=0.374).
TCASD under transthoracic echocardiographic and fluoroscopic guidance in patients with ASD secundum and depletion of aortic rims using ASOD and no balloon sizing is safe and effective and the results are comparable with TCASD in those with adequate aortic rim in terms of high success rate, less complications and less fluoroscopic time.
STRUCTURAL: Congenital and Other Structural Heart Disease