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Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer ™ Septal Occluder

Published online by Cambridge University Press:  19 August 2008

Felix Berger ,
Peter Ewert ,
Per G. Boöjrnstad ,
Ingo Dähnert ,
Gregor Krings ,
Ira Brilla-Austenat ,
Michael Vogel  and
Peter E. Lange
Felix Berger*
Affiliation:
Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
Peter Ewert
Affiliation:
Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
Per G. Boöjrnstad
Affiliation:
Rikshospitalet, Oslo, Norway
Ingo Dähnert
Affiliation:
Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
Gregor Krings
Affiliation:
Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
Ira Brilla-Austenat
Affiliation:
Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
Michael Vogel
Affiliation:
Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
Peter E. Lange
Affiliation:
Klinik für Angeborene Herzfehler, Deutsches Herzzentrum Berlin, Berlin, Germany
*
Felix Berger, MD, Deutsches Herzzentrum Berlin, Klinik für Angeborene Herzfehler, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: 49 30 4593 2800; Fax: 49 30 4593 2900; E-mail: [email protected]
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Abstract

To judge whether an Amplatzer™ Septal Occluder can be used as standard therapy instead of surgery for closure of atrial septal defects we report our experiences in 200 patients. Of these patients, 127 had an atrial septal defect with haemodynamically significant left-to-right shunt, 68 patients a persistent oval foramen after presumed paradoxical embolism, and 5 had a fenestration after Fontan-repair. Mean age was 29.8 years (0.8 to 77.7 years). Body weight ranged from 6.9 to 120.0 kg (mean 51.5 kg). After diagnostic cardiac catheterization, and balloon-sizing of the defect, we implanted Amplatzer™ Septal Occluders with stents of 4 to 28 mm diameter. Follow-up studies were obtained after 48hours, and one, six, and twelve months. Transcatheter closure of the atrial septal defect proved successful in all without any relevant residual shunts. In particular, complete closure was achieved in all patients after presumed paradoxical embolism. The mean period of follow-up is 9–5 months, with a range from 0.4 to 23.5 months, giving a total of 1898 patient months. The occlusion rate after three month was 98.1°. A trivial haemodynamically insignificant residual shunt remained in 1.9° of the patients. Fluoroscopy times ranged from 0 to 43.5 minutes, with a median of 8.7 minutes. The excellent results in the short and medium term in children and adults have resulted in using this device routinely at the present time for closure of central atrial septal defects up to a diameter of 28 mm. Final judgement, however, is only possible after long-term follow-up.

Keywords

Atrial septal defectinterventional cardiologytranscatheter closureAmplatzer™ Septal Occluder
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 5 , September 1999 , pp. 468 - 473
Copyright
Copyright © Cambridge University Press 1999

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References

1.Murphy, JG, Gersh, BJ, McGoon, MD, et al. Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med 1990; 323: 1645–1650.CrossRefGoogle ScholarPubMed
2.Horvath, KA, Burke, RP, Collins, JJ Jr,, Cohn, LH.Surgical treatment of adult atrial septal defect: early and long-term results. J Am Coll Cardiol 1992; 20: 1156–1159.CrossRefGoogle ScholarPubMed
3.Meijboom, F, Hess, J, Szatmari, A, Utens, EM, McGhie, J, Deckers, JW, Roelandt, JR, Bos, E.Long-term follow-up (9 to 20 years) after surgical closure of atrial septal defect at a young age. Am J Cardiol 1993; 72: 1431–1434.CrossRefGoogle ScholarPubMed
4.Mandelik, J, Moodie, DS, Sterba, R, Murphy, D, Rosenkranz, E, Medendorp, S, Kovaks, A.Long-term follow-up of children after repair of atrial septal defects. Cleve Clin J Med 1994; 61: 29–33; quiz 80–82.CrossRefGoogle ScholarPubMed
5.Konstantinides, S, Geibel, A, Olschewski, M, Gornandt, L, Roskamm, H, Spillner, G, Just, H, Kasper, W.A comparison of surgical and medical therapy for atrial septal defect in adults. N Engl J Med 1995; 333: 469–473.CrossRefGoogle ScholarPubMed
6.Meisel, S, Levi, A, David, D.Atrial septal defect in the adult: clinical course with medical treatment, pre-operative risk, and long-term postoperative survival. Harefuah 1997; 132: 490–494.Google ScholarPubMed
7.King, TD, Thompson, SL, Steiner, C, Mills, NL.Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. Jama 1976; 235: 2506–2509.CrossRefGoogle ScholarPubMed
8.Mills, NL, King, TD, Thompson, SL.Umbrella catheter for nonoperative closure of atrial septal defects. Med Instrum 1978; 12: 65–69.Google ScholarPubMed
9.Lock, JE, Rome, JJ, Davis, R, Van Praagh, S, Perry, SB, Van Praagh, R, Keane, JF.Transcatheter closure of atrial septal defects. Experimental studies. Circulation 1989; 79: 1091–1099.CrossRefGoogle ScholarPubMed
10.Rao, PS, Wilson, AD, Chopra, PS.Transcatheter closure of atrial septal defect by “buttoned” devices. Am J Cardiol 1992; 69: 1056–1061.CrossRefGoogle ScholarPubMed
11.Das, GS, Voss, G, Jarvis, G, Wyche, K, Gunther, R, Wilson, RF.Experimental atrial septal defect closure with a new, transcatheter, self-centering device. Circulation 1993; 88: 1754–1764.CrossRefGoogle ScholarPubMed
12.Mandell, VS, Nimkin, K, Hoffer, FA, Bridges, ND.Devices for transcatheter closure of intracardiac defects. AJR Am J Roentgenol 1993; 160: 179–184.CrossRefGoogle ScholarPubMed
13.Rao, PS.Transcatheter closure of atrial septal defect: are we there yet? J Am Coll Cardiol 1998; 31: 1117–1119.Google ScholarPubMed
14.Lloyd, TR, Rao, PS, Beekman, RHr, Mendelsohn, AM, Sideris, EB.Atrial septal defect occlusion with the buttoned device (a multiinstitutional U.S. trial). Am J Cardiol 1994; 73: 286–291.CrossRefGoogle ScholarPubMed
15.Sievert, H, Babic, UU, Ensslen, R, Scherer, D, Spies, H, Wiederspahn, T, Zeplin, HE.Transcatheter closure of large atrial septal defects with the Babic system. Cathet Cardiovasc Diagn 1995; 36: 232–240.CrossRefGoogle ScholarPubMed
16.Hijazi, ZM.New closure devices for left-to-right shunt. Indian Heart J 1996; 48: 119–123.Google ScholarPubMed
17.Sideris, EB, Leung, M, Yoon, JH, Chen, CR, Lochan, R, Worms, AM, Rey, C, Meier, B.Occlusion of large atrial septal defects with a centering buttoned device: early clinical experience. Am Heart J 1996; 131: 356–359.CrossRefGoogle ScholarPubMed
18.Rickers, C, Hamm, C, Stern, H, Hofmann, T, Franzen, O, Schrader, 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.Percutaneous closure of secundum atrial septal defect with a new self centering device (“angel wings”). Heart 1998; 80: 517–521.CrossRefGoogle ScholarPubMed
19.Walsh, KP, Tofeig, M, Peart, I, Kitchiner, DJ, Arnold, R.Comparative effectiveness of the Sideris and Amplatzer occlusion devices (abstract). Cardiol Young 1998; 9: 11–12.Google Scholar
20.Wilkinson, JL, Goh, TH.Early clinical experience with use of the ‘Amplatzer Septal Occluder’ device for atrial septal defect. Cardiol Young 1998; 8: 295–302.CrossRefGoogle ScholarPubMed
21.Rigby, ML.The era of transcatheter closure of atrial septal defects. Heart 1999; 81: 227–228.CrossRefGoogle ScholarPubMed
22.Bridges, ND, Hellenbrand, W, Latson, L, Filiano, J, Newburger, JW, Lock, JE.Transcatheter closure of patent foramen ovale after presumed paradoxical embolism. Circulation 1992; 86: 1902–1908.CrossRefGoogle ScholarPubMed
23.Chan, KC, Godman, MJ.Morphological variations of fossa ovalis atrial septal defects (secundum): feasibility for transcutaneous closure with the clam-shell device. Br Heart J 1993; 69: 52–55.CrossRefGoogle ScholarPubMed
24.Prieto, LR, Foreman, CK, Cheatham, JP, Latson, LA.Intermediate-term outcome of transcatheter secundum atrial septal defect closure using the Bard Clamshell Septal Umbrella. Am J Cardiol 1996; 78: 1310–1312.CrossRefGoogle ScholarPubMed
25.Ende, DJ, Chopra, PS, Rao, PS.Transcatheter closure of atrial septal defect or patent foramen ovale with the buttoned device for prevention of recurrence of paradoxic embolism. Am J Cardiol 1996; 78: 233–236.CrossRefGoogle ScholarPubMed
26.Hausdorf, G, Schneider, M, Franzbach, B, Kampmann, C, Kargus, K, Goeldner, B.Transcatheter closure of secundum atrial septal defects with the atrial septal defect occlusion system (ASDOS): initial experience in children. Heart 1996; 75: 83–88.CrossRefGoogle ScholarPubMed
27.Bjornstad, PG, Masura, J, Thaulow, E, Smevik, B, Michelsen, SS, Tonnessen, TI, Seem, E, Fosse, E.Interventional closure of atrial septal defects with the Amplatzer device: first clinical experience. Cardiol Young 1997; 7: 277–283.CrossRefGoogle Scholar
28.Berger, F, Uhlemann, F, Nurnberg, JH, Haas, NA, Lange, PE.Is transcatheter occlusion of a persistent foramen ovale a possibility for the avoidance of a paradoxical embolism? Dtsch Med Wochenschr 1997; 122: 1371–1376.CrossRefGoogle ScholarPubMed
29.Formigari, R, Santoro, G, Rossetti, L, Rinelli, G, Guccione, P, Ballerini, L.Comparison of three different atrial septal defect occlusion devices. Am J Cardiol 1998; 82: 690–2, A9.CrossRefGoogle ScholarPubMed
30.Arabia, FA, Rosado, LJ, Lloyd, TR, Sethi, GK.Management of complications of Sideris transcatheter devices for atrial septal defect closure. J Thorac Cardiovasc Surg 1993; 106: 886–888.CrossRefGoogle ScholarPubMed
31.Agarwal, SK, Ghosh, PK, Mittal, PK.Failure of devices used for closure of atrial septal defects: mechanisms and management. J Thorac Cardiovasc Surg 1996; 112:21–26.CrossRefGoogle ScholarPubMed
32.Gildein, HP, Dabritz, S, Geibel, A, Sarai, K, Vazquez-Jimenez, J, Hugel, W, Mocellin, R.Transcatheter closure of atrial septal defects by the “buttoned” device: complications and need for surgical revision. Pediatr Cardiol 1997; 18: 328–331.CrossRefGoogle ScholarPubMed
33.Bohm, J, Bittigau, K, Kohler, F, Baumann, G, Konertz, W.Surgical removal of atrial septal defect occlusion system- devices. Eur J Cardiothorac Surg 1997; 12: 869–872.CrossRefGoogle ScholarPubMed
34.Bjornstad, PG, Smevik, B, Fiane, AE, Tonnessen, TI, Fosse, E.Catheter based closure of atrial septal defects with a newly developed Nitinol double disc: an experimental study. Cardiol Young 1997; 7: 220–224.CrossRefGoogle Scholar
35.Thanopoulos, BD, Laskari, CV, Tsaousis, GS, Zarayelyan, A, Vekiou, A, Papadopoulos, GS.Closure of atrial septal defects with the Amplatzer occlusion device: preliminary results. J Am Coll Cardiol 1998; 31: 1110–1116.CrossRefGoogle ScholarPubMed
36.Berger, F, Ewert, P, Stiller, B, Dahnert, I, Krings, G, Vogel, M, Lange, PE.Initial clinical results with the Amplatzer Septal Occluder- a self-centering double-disc device for the occlusion of atrial septal defects. Z Kardiol 1998; 87: 185–190.Google ScholarPubMed
37.Björnstad, PG, Thaulow, E, Smevik, B, Michelsen, SS, Tonnessen, TI, Fosse, E.Catheter treatment of congenital heart defects. Atrial septal defects and open ductus arteriosus. Tidsskr Nor Laegeforen 1997; 117: 2961–2964.Google ScholarPubMed