Heart 1999;82:300-306 ( September )

Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience

K C Chan^a, M J Godman^b, K Walsh^c, N Wilson^d, A Redington^e, J L Gibbs^f

^a Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK, ^b Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK, ^c Alder Hey Children's Hospital, Liverpool L12 2AP, UK, ^d Royal Hospital for Sick Children, Glasgow G3 8SL, UK, ^e Brompton Hospital, Sydney Street, London SW3 6NP, UK, ^f Yorkshire Heart Institute, Leeds LS1 3EX, UK

Correspondence to: Dr Chan. email: chen.chan{at}glenfield-tr.trent.nhs.uk

Accepted for publication 11 January 1999

OBJECTIVETo review the safety and efficacy of the Amplatzer septal occluder for transcatheter closure of interatrial communications (atrial septal defects (ASD), fenestrated Fontan (FF), patent foramen ovale (PFO)).
DESIGNProspective study following a common protocol for patient selection and technique of deployment in all participating centres.
SETTINGMulticentre study representing total United Kingdom experience.
PATIENTSFirst 100 consecutive patients in whom an Amplatzer septal occluder was used to close a clinically significant ASD or interatrial communication.
INTERVENTIONSAll procedures performed under general anaesthesia with transoesophageal echocardiographic guidance. Interatrial communications were assessed by transoesophageal echocardiography with reference to size, position in the interatrial septum, proximity to surrounding structures, and adequacy of septal rim. Stretched diameter of the interatrial communications was determined by balloon sizing. Device selection was based on and matched to the stretched diameter of the communication.
MAIN OUTCOME MEASURESSuccess defined as deployment of device in a stable position to occlude the interatrial communication without inducing functional abnormality or anatomical obstruction. Occlusion status determined by transoesophageal echocardiography during procedure and by transthoracic echocardiography on follow up. Clinical status and occlusion rates assessed at 24 hours, one month, and three months.
RESULTS101 procedures were performed in 100 patients (86 ASD, 7 FF, 7 PFO), age 1.7 to 64.3 years (mean (SD), 13.3 (13.9)), weight 9.2 to 100.0 kg (mean 32.5 (23.5)). Procedure time ranged from 30 to 180 minutes (mean 92.4 (29.0)) and fluoroscopy time from 6.0 to 49.0 minutes (mean 16.1 (8.0)). There were seven failures, all occurring in patients with ASD, and one embolisation requiring surgical removal. Immediate total occlusion rate was 20.4%, rising to 84.9% after 24 hours. Total occlusion rates at the one and three month follow up were 92.5% and 98.9%, respectively. Complications were: transient ST elevation (1), transient atrioventricular block (1), presumed deep vein thrombosis (1), presumed transient ischaemic attack (1).
CONCLUSIONSIt appears feasible to close interatrial communications and atrial septal defects up to 26 mm stretched diameter safely with the Amplatzer septal occluder. Short term results confirm an early high occlusion rate with no major complications. Careful selection of cases based on the echocardiographic morphology of the ASD and accurate assessment of their stretched diameter is of utmost importance. Further experience with the larger devices and longer term results are required before a firm conclusion regarding its use can be made.


Keywords: interatrial communications; atrial septal defect; Amplatzer septal occluder; congenital heart defects

---

© 1999 by Heart
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Balzer, J., van Hall, S., Rassaf, T., Boring, Y.-C., Franke, A., Lang, R. M., Kelm, M., Kuhl, H. P. (2009). Feasibility, safety, and efficacy of real-time three-dimensional transoesophageal echocardiography for guiding device closure of interatrial communications: initial clinical experience and impact on radiation exposure. Eur J Echocardiogr 0: jep116v1-jep116 [Abstract] [Full Text]  
• Balzer, J., Kelm, M., Kuhl, H. P. (2009). Real-time three-dimensional transoesophageal echocardiography for guidance of non-coronary interventions in the catheter laboratory. Eur J Echocardiogr 10: 341-349 [Abstract] [Full Text]  
• Yared, K., Baggish, A. L., Solis, J., Durst, R., Passeri, J. J., Palacios, I. F., Picard, M. H. (2009). Echocardiographic Assessment of Percutaneous Patent Foramen Ovale and Atrial Septal Defect Closure Complications. Circ Cardiovasc Imaging 2: 141-149 [Full Text]  
• Thomson, L. E.J., Crowley, A. L., Heitner, J. F., Cawley, P. J., Weinsaft, J. W., Kim, H. W., Parker, M., Judd, R. M., Harrison, J. K., Kim, R. J. (2008). Direct En Face Imaging of Secundum Atrial Septal Defects by Velocity-Encoded Cardiovascular Magnetic Resonance in Patients Evaluated for Possible Transcatheter Closure. Circ Cardiovasc Imaging 1: 31-40 [Abstract] [Full Text]  
• Hongxin, L., Lijun, S., Wang, Z.-j., Zi, J., Zhang, W.-l., Zhang, H.-z., Wenbin, G., Zou, C.-w. (2008). Intraoperative device closure of large secundum atrial septal defects; a safe alternative to transcatheter closure. Eur. J. Cardiothorac. Surg. 33: 1055-1060 [Abstract] [Full Text]  
• Albers, G. W., Amarenco, P., Easton, J. D., Sacco, R. L., Teal, P. (2008). Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: 630S-669S [Abstract] [Full Text]  
• Singh, S. M., Das, S. (2008). Delayed Heart Block After Temporary Balloon Occlusion of a Secundum Atrial Septal Defect.. Circ Arrhythm Electrophysiol 1: 405-406 [Full Text]  
• Maimon, M. S., Ratnapalan, S., Do, A., Kirsh, J. A., Wilson, G. J., Benson, L. N. (2006). Cardiac Perforation 6 Weeks After Percutaneous Atrial Septal Defect Repair Using an Amplatzer Septal Occluder. Pediatrics 118: e1572-e1575 [Abstract] [Full Text]  
• Teoh, K., Wilton, E., Brecker, S., Jahangiri, M. (2006). Simultaneous removal of an Amplatzer device from an atrial septal defect and the descending aorta. J. Thorac. Cardiovasc. Surg. 131: 909-910 [Full Text]  
• Risius, T., Lewalter, T., Luderitz, B., Schwab, J. O., Spitzer, S., Schmitt, C., Vester, E., Rostock, T., Meinertz, T., Willems, S. (2006). Transient ST-segment-elevation during pulmonary vein ablation using circumferential coiled microelectrodes in a prospective multi-centre study.. Europace 8: 178-181 [Abstract] [Full Text]  
• Russell, I. A., Rouine-Rapp, K., Stratmann, G., Miller-Hance, W. C. (2006). Congenital heart disease in the adult: a review with internet-accessible transesophageal echocardiographic images.. Anesth. Analg. 102: 694-723 [Full Text]  
• Vida, V. L., Barnoya, J., O'Connell, M., Leon-Wyss, J., Larrazabal, L. A., Castaneda, A. R. (2006). Surgical Versus Percutaneous Occlusion of Ostium Secundum Atrial Septal Defects: Results and Cost-Effective Considerations in a Low-Income Country. J Am Coll Cardiol 47: 326-331 [Abstract] [Full Text]  
• Spence, M S, Qureshi, S A (2005). Complications of transcatheter closure of atrial septal defects. Heart 91: 1512-1514 [Abstract] [Full Text]  
• Lammers, A., Hager, A., Eicken, A., Lange, R., Hauser, M., Hess, J. (2005). Need for closure of secundum atrial septal defect in infancy. J. Thorac. Cardiovasc. Surg. 129: 1353-1357 [Abstract] [Full Text]  
• Salehian, O., Horlick, E., Schwerzmann, M., Haberer, K., McLaughlin, P., Siu, S. C., Webb, G., Therrien, J. (2005). Improvements in cardiac form and function after transcatheter closure of secundum atrial septal defects. J Am Coll Cardiol 45: 499-504 [Abstract] [Full Text]  
• Albers, G. W., Amarenco, P., Easton, J. D., Sacco, R. L., Teal, P. (2004). Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126: 483S-512S [Abstract] [Full Text]  
• Lovell, A. T. (2004). Anaesthetic implications of grown-up congenital heart disease. Br J Anaesth 93: 129-139 [Abstract] [Full Text]  
• Suda, K., Raboisson, M.-J., Piette, E., Dahdah, N. S., Miro, J. (2004). Reversible atrioventricular block associated with closure of atrial septal defects using the amplatzer device. J Am Coll Cardiol 43: 1677-1682 [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]  
• Earing, M. G., Cabalka, A. K., Seward, J. B., Bruce, C. J., Reeder, G. S., Hagler, D. J. (2004). Intracardiac Echocardiographic Guidance During Transcatheter Device Closure of Atrial Septal Defect and Patent Foramen Ovale. Mayo Clin Proc. 79: 24-34 [Abstract]  
• 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]  
• Lin, S.-M., Tsai, S.-K., Wang, J.-K., Han, Y.-Y., Jean, W.-h., Yeh, Y.-C. (2003). Supplementing Transesophageal Echocardiography with Transthoracic Echocardiography for Monitoring Transcatheter Closure of Atrial Septal Defects with Attenuated Anterior Rim: A Case Series. Anesth. Analg. 96: 1584-1588 [Abstract] [Full Text]  
• Fischer, G, Stieh, J, Uebing, A, Hoffmann, U, Morf, G, Kramer, H H (2003). Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients. Heart 89: 199-204 [Abstract] [Full Text]  
• Mullen, M. J., Dias, B. F., Walker, F., Siu, S. C., Benson, L. N., McLaughlin, P. R. (2003). Intracardiac echocardiography guided device closure of atrial septal defects. J Am Coll Cardiol 41: 285-292 [Abstract] [Full Text]  
• Verma, P. K., Thingnam, S. K. S., Sharma, A., Taneja, J. S., Varma, J. S., Grover, A. (2003). Delayed Embolization of Amplatzer Septal Occluder Device: An Unknown Entity: A Case Report. ANGIOLOGY 54: 115-118 [Abstract]  
• Hughes, M L, Maskell, G, Goh, T H, Wilkinson, J L (2002). Prospective comparison of costs and short term health outcomes of surgical versus device closure of atrial septal defect in children. Heart 88: 67-70 [Abstract] [Full Text]  
• Braun, M. U., Fassbender, D., Schoen, S. P., Haass, M., Schraeder, R., Scholtz, W., Strasser, R. H. (2002). Transcatheter closure of patent foramen ovale in patients with cerebral ischemia. J Am Coll Cardiol 39: 2019-2025 [Abstract] [Full Text]  
• Downing, S. W., Herzog, W. A Jr, McLaughlin, J. S., Gilbert, T. P. (2002). Beating-heart mitral valve surgery: Preliminary model and methodology. J. Thorac. Cardiovasc. Surg. 123: 1141-1146 [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]  
• Chessa, M., Carminati, M., Butera, G., Bini, R. M., Drago, M., Rosti, L., Giamberti, A., Pome, G., Bossone, E., Frigiola, A. (2002). Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol 39: 1061-1065 [Abstract] [Full Text]  
• Strotmann, J M, Voelker, W, Schanzenbaecher, P (2001). Persistence of the eustachian valve in secundum atrial septal defects: possible implications for cerebral embolism and transcatheter closure procedures. Heart 86: e5-5 [Abstract] [Full Text]  
• Veldtman, G. R., Razack, V., Siu, S., El-Hajj, H., Walker, F., Webb, G. D., Benson, L. N., McLaughlin, P. R. (2001). Right ventricular form and function after percutaneous atrial septal defect device closure. J Am Coll Cardiol 37: 2108-2113 [Abstract] [Full Text]  
• Acar, P, Saliba, Z, Bonhoeffer, P, Sidi, D, Kachaner, J (2001). Assessment of the geometric profile of the Amplatzer and Cardioseal septal occluders by three dimensional echocardiography. Heart 85: 451-453 [Abstract] [Full Text]  
• ALP, N., CLARKE, N., BANNING, A. P (2001). How should patients with patent foramen ovale be managed?. Heart 85: 242-244 [Full Text]