Midterm outcomes of transcatheter closure of atrial septal defect using the amplatzer septal occluder in children

Abstract

Purpose: This study reports the clinical experience and midterm outcomes of transcatheter closure of secundum atrial septal defect with the Amplatzer septal occluder in children. Methods: From April 1998 to June 2002, 41 children (male = 14) with a median age of 11.0 years (range = 3.2-18.9 years) and median weight of 31.5 kg (range = 13.5-65 kg) underwent transcatheter closure of secundum atrial septal defect using the Amplatzer Septal Occluder after a detailed pre-implantation evaluation. The procedures were performed under general anaesthesia with fluoroscopic guidance and transesophageal echocardiographic monitoring. The size of the device deployed was determined by the balloon-stretched diameter of the defect. Patients were followed for any residual shunts and possible complications. Results: The mean diameter of atrial septal defect measured by transesophageal echocardiography was 14.3±4.1 mm and 19.2±4.7 mm by balloon-stretched diameter. The mean device diameter was 19.2±4.7 mm (range = 11-30 mm). The mean fluoroscopy time was 17.3 minutes (range = 7.4 to 30 minutes) and the mean procedure time was 100 minutes (range = 35-190 minutes). All devices were successfully deployed. Two patients developed transient atrioventricular dissociation with spontaneous recovery. Complete closure rate at 24 hours, one week, one, 6 and 12 months were 83% [90% confidence limit (CL): 73-91%], 93% (90% CL: 84-97%), 95% (90% CL: 81-96%) and 97% (90% CL: 91-99%), respectively. The mean follow-up period was 46.5±18.6 months (range = 10.7-86.6 months). All devices were in stable position with no late complications. Conclusions: Transcatheter closure of atrial septal defect using the Amplatzer Septal Occluder is safe and effective in children. The midterm results are excellent. However, long-term follow-up is needed to ascertain the absence of possible late complications.