Transcatheter closure of secundum atrial septal defects with the atrial septal defect occlusion system (ASDOS): initial experience in children.

G. Hausdorf, M. Schneider, B. Franzbach, C. Kampmann, K. Kargus, B. Goeldner

Department of Paediatric Cardiology, Humboldt-University, Berlin, Germany.

OBJECTIVE--To report initial experiences with transcatheter occlusion of atrial septal defects using a new occlusion device. SUBJECTS--10 children aged 1.1 to 14.9 years. INCLUSION CRITERIA--Patients with a body weight above 10 kg, normal pulmonary resistance and an indication for surgical closure of a secundum atrial septal defect, a residual tissue rim of interatrial septum surrounding the defect of more than 5 mm, and a maximum defect diameter of 20 mm. METHODS--The defects were closed by a transcatheter device (ASDOS) consisting of two umbrellas which are introduced over a guidewire loop. Both umbrellas consist of a central body and five arms formed from preshaped nitinol wire covered with a thin polyurethane patch. The central body of the distal umbrella contains a thread, the proximal umbrella contains a bolt. The two umbrellas are connected by screwing the bolt on the thread using a screwdriver catheter. RESULTS--The implantation was performed under echocardiographic guidance; in six of 10 patients, transoesophageal echocardiography was necessary. The "stretched" diameter of the defect evaluated during balloon sizing ranged from 10 to 20 mm, and the pulmonary to systemic blood flow ratio from 1.5:1 to 2.8:1. Transcatheter closure was successfully performed in 9/10 patients using devices with a diameter of 25 mm to 40 mm. No severe complications occurred. However, in one patient with a pre-existing prolonged PR interval brief periods of second and third degree atrioventricular block occurred after the implantation but normalised within 3 d. During a follow up period of 21 to 29 weeks no device embolisation, thromboembolic complications, fractures of the implanted device, atrial perforations, pericardial effusions, obstructions of systemic or pulmonary veins, atrioventricular valve dysfunction, or other complications occurred. CONCLUSIONS--The new device is a promising transcatheter approach for the occlusion of secundum atrial septal defects in children. However, further evaluation and long term data are needed before this transcatheter technique can be recommended.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Hijazi, Z. M., Awad, S. M. (2008). Pediatric Cardiac Interventions. J Am Coll Cardiol Intv 1: 603-611 [Abstract] [Full Text]  
• Krumsdorf, U., Ostermayer, S., Billinger, K., Trepels, T., Zadan, E., Horvath, K., Sievert, H. (2004). Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol 43: 302-309 [Abstract] [Full Text]  
• Zanchetta, M., Onorato, E., Rigatelli, G., Pedon, L., Zennaro, M., Carrozza, A., Maiolino, P. (2003). Intracardiac echocardiography-guided transcatheter closure of secundum atrial septal defect: A new efficient device selection method. J Am Coll Cardiol 42: 1677-1682 [Abstract] [Full Text]  
• Thomson, J D R, Aburawi, E H, Watterson, K G, Van Doorn, C, Gibbs, J L (2002). Surgical and transcatheter (Amplatzer) closure of atrial septal defects: a prospective comparison of results and cost. Heart 87: 466-469 [Abstract] [Full Text]  
• McMahon, C J, Feltes, T F, Fraley, J K, Bricker, J T, Grifka, R G, Tortoriello, T A, Blake, R, Bezold, L I (2002). Natural history of growth of secundum atrial septal defects and implications for transcatheter closure. Heart 87: 256-259 [Abstract] [Full Text]  
• Rao, P. S., Berger, F., Rey, C., Haddad, J., Meier, B., Walsh, K. P., Chandar, J. S., Lloyd, T. R., Suarez de Lezo, J., Zamora, R., Sideris, E. B., for the International Buttoned Device Trial Group, (2000). Results of transvenous occlusion of secundum atrial septal defects with the fourth generation buttoned device: comparison with first, second and third generation devices. J Am Coll Cardiol 36: 583-592 [Abstract] [Full Text]  
• Maeno, Y V, Benson, L N, McLaughlin, P R, Boutin, C (2000). Dynamic morphology of the secundum atrial septal defect evaluated by three dimensional transoesophageal echocardiography. Heart 83: 673-677 [Abstract] [Full Text]  
• Berger, F., Vogel, M., Alexi-Meskishvili, V., Lange, P. E. (1999). COMPARISON OF RESULTS AND COMPLICATIONS OF SURGICAL AND AMPLATZER DEVICE CLOSURE OF ATRIAL SEPTAL DEFECTS. J. Thorac. Cardiovasc. Surg. 118: 674-678 [Abstract] [Full Text]  
• Chan, K C, Godman, M J, Walsh, K, Wilson, N, Redington, A, Gibbs, J L (1999). Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience. Heart 82: 300-306 [Abstract] [Full Text]  
• Amin, Z., Gu, X., Berry, J. M., Bass, J. L., Titus, J. L., Urness, M., Han, Y.-M., Amplatz, K. (1999). New Device for Closure of Muscular Ventricular Septal Defects in a Canine Model. Circulation 100: 320-328 [Abstract] [Full Text]  
• Fischer, G., Kramer, H.H., Stieh, J., Harding, P., Jung, O. (1999). Transcatheter closure of secundum atrial septal defects with the new self-centering Amplatzer Septal Occluder. Eur Heart J 20: 541-549 [Abstract]  
• RIGBY, M. L (1999). The era of transcatheter closure of atrial septal defects. Heart 81: 227-228 [Full Text]  
• Walsh, K P, Wilmshurst, P T, Morrison, W L (1999). Transcatheter closure of patent foramen ovale using the Amplatzer septal occluder to prevent recurrence of neurological decompression illness in divers. Heart 81: 257-261 [Abstract] [Full Text]  
• Thomsen, A B., Schneider, M, Baandrup, U, Stenbøg, E V, Hasenkam, J M, Bagger, J P, Hausdorf, G (1998). Animal experimental implantation of an atrial septal defect occluder system. Heart 80: 606-611 [Abstract] [Full Text]  
• Rickers, C, Hamm, C, Stern, H, Hofmann, T, Franzen, O, Schräder, R, Sievert, H, Schranz, D, Michel-Behnke, I, Vogt, J, Kececioglu, D, Sebening, W, Eicken, A, Meyer, H, Matthies, W, Kleber, F, Hug, J, Weil, J (1998). Percutaneous closure of secundum atrial septal defect with a new self centring device ("angel wings"). Heart 80: 517-521 [Abstract] [Full Text]  
• Kaulitz, R, Paul, T, Hausdorf, G (1998). Extending the limits of transcatheter closure of atrial septal defects with the double umbrella device (CardioSEAL). Heart 80: 54-59 [Abstract] [Full Text]  
• Allen, H. D., Beekman, R. H. III, Garson, A. Jr, Hijazi, Z. M., Mullins, C., O'Laughlin, M. P., Taubert, K. A. (1998). Pediatric Therapeutic Cardiac Catheterization : A Statement for Healthcare Professionals From the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 97: 609-625 [Full Text]  
• Sharafuddin, M. J. A., Gu, X., Titus, J. L., Urness, M., Cervera-Ceballos, J. J., Amplatz, K. (1997). Transvenous Closure of Secundum Atrial Septal Defects : Preliminary Results With a New Self-Expanding Nitinol Prosthesis in a Swine Model. Circulation 95: 2162-2168 [Abstract] [Full Text]