PERCUTANEOUS CLOSURE OF SECUNDUM ATRIAL SEPTAL DEFECT WITH AMPLTAZER SEPTAL OCCLUDER: EXPERIENCE ON 17 CONSECUTIVES CASES:

During the last 20 years, different devices had been used for the percutaneous closure of atrial septal defect (ASD). Most of these had a limited diffusion because of the scarce manoeuvrability, the high rate of residual shunt and the frequent migrations and the difficulties for the retrieval. Since september 1998 a new device is available , Amplatzer Septal Occluder (AGA Medical Co., Golden Valley, MN, USA)
, which has overstepped these problems and is actually world wide used. Patients: between November 98 and June 2000, 17 consecutives patients (9 M, 8 F) with ostium secundum ASD diagnosed at ecoDoppler, aged from 3,2 to 19,7 years (mean 9,7 years), weight between 13,5 and 73 kg (mean 34 kg), underwent cardiac catheterization for the closure of an ASD with ASO.
Methods: The procedure is carry out under general anaesthesia and transesophageal echocardiography (TEE) monitoring.
ASO is a self- expanding and self-centering double-disc device constructed of a dense mesh of nitinol wire . The two discs are connected by a short cylindrical waist, which corrects the cardiopathy stenting the defect. Polyester patches present in the discs and the waist induce blood coagulation and ASD closure. The device is produced in different sizes from 4 to 38 mm (the size is the diameter of the waist which has to correspond to the stretched diameter of the defect determined by a ballon-tipped catheter). The appropriate device is introduced with his delivery system in the catheter; the left atrial disc is deployed in the left atrium, the waist through the defect and the right atrial disc in the right atrium, under fluoroscopic and TEE guidance.
Assesed that the device position is satifactory, the ASO is unscrewed from the delivery system, a mechanism which prevents accidental detachment and allows retrieval if necessary. Twenty-four hours later the patient undegoes a complete ecoDoppler study and chest radiography and is discharged with the recommendation of the bacterial endocarditis prophylaxis for 6 months. Results: in 16 cases the procedure was completed. One case was excluded because of multiple ASD. The complete closure, evaluated at 6 months with ecoDoppler study, was obtained in all 16 cases (100%).
A residual shunt present in 50% of the patients immediately after the procedure disappeared during the successive 6 months. The average procedure time was 100 minutes. No immediate complication. Follow-up: 6-24 months (mean 18,3 months) with ecoDoppler study at 1 month, 6 months and then six-monthly. No complication. Conclusions: In our experience and in literature, ASO has demonstrated high efficiency in achievement of complete closure of ASD, ease in fixing, possibility of retrieval, low risk of complication.

Actually percutaneous closure with ASO represents the treatment of choice for secundum atrial septal defect. Bibliography: Masura J. Et al. Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder: initial human experience. Cathet Cardiovasc Diagn 1997, 42: 388-393 Hijazi Z. M. et al. Catheter closure of ASD using Amplatzer septal occluder: results of international clinical trial. In 3rd International Amplatzer Symposium, Strasbourg, June 2000, p. 7.

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