Interventional cardiology surgery
Morphology of perforated atrial septal aneurysm suitable for
closure by transcatheter device placement
P Ewerta, F Bergera, M Vogela, I Dähnerta, V Alexi-Meshkishvilib, P E Langea
a Department of
Congenital Heart Disease, Deutsches Herzzentrum Berlin, Augustenburger
Platz 1, 13353 Berlin, Germany, b Department of Cardiac Surgery, Deutsches
Herzzentrum Berlin
Correspondence to: Dr Ewert email: ewert{at}dhzb.de
Accepted 2 May 2000
OBJECTIVE
To define the morphological
criteria of perforated atrial septal aneurysms suitable for closure by
a transcatheter device.
METHODSA retrospective analysis of
all consecutive patients with atrial septal aneurysm and one or more
perforations presenting between May 1997 and June 1999. The aneurysms
were classified as: aneurysm with persistent foramen ovale (type A);
aneurysm with single atrial septal defect (type B); aneurysm with two
perforations requiring more than one device for closure (type C); and
aneurysm with multiple perforations (type D).
PATIENTSData from 50 patients aged
5-78 years (mean 43 years) were analysed; 32 had systemic
thromboembolism or transient ischaemic attacks, eight presented with
dyspnoea on exercise, and 10 were discovered incidentally but had
significant left to right shunt and right ventricular volume overload.
RESULTSIn all 18 patients with
aneurysm and persistent foramen ovale (type A), transcatheter closure
was possible. In nine with aneurysm and atrial septal defect (type B),
five defects were closed and four required surgery. Device closure was
achieved in all 10 patients with aneurysms and two perforations (type
C), but four had a residual shunt. Thirteen patients with multiple
perforated aneurysms (type D) underwent surgery.
CONCLUSIONSThis classification of
morphology of perforations of aneurysm is clinically useful for
selecting patients for treatment by transcatheter devices.
Keywords: aneurysm; atrial septum; transcatheter device
© 2000 by Heart
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