Title:
Feasibility of transcatheter closure in unselected patients with secundum atrial septal defect, using Amplatzer devices and a modified sizing balloon technique.

Abstract:
We aimed to assess (1) the role of surgical versus transcatheter closure techniques and (2) the impact of a modified implantation technique to optimize closure of secundum septal defects with the Amplatzer device.
Despite several comparative studies, the respective roles of surgical and transcatheter closure are not clarified. Additionally, the impact of modified method of implantation on device closure remains unknown.
Fifty-seven unselected patients were referred for secundum atrial septal defect closure in 2009, at a median age and weight of 27.5 (0.8-88) years and 40.6 (5.6-97) kg, respectively. Transcatheter closure was attempted in 53 cases under transesophagal echocardiography guidance in children (n = 28) and intracardiac echocardiography guidance in adults. If standard closure failed, a sizing balloon catheter inflated in the left atrium was used as a support to secure the position of the device upon deployment.
Fifty of the 57 cases (88%) were successfully closed with a median Amplatzer Septal Occluder size of 20 (10-40) mm, using the sizing balloon technique in eight (16%) cases. No major complication occurred. A trivial residual shunt remained in two patients (4%) whereas a mild mitral regurgitation appeared in one. By univariate analysis, a deficient superior-posterior rim and a large defect (>15 mm(2) /m(2) ) were associated with the use of the sizing balloon technique (P = 0.04 and 0.03, respectively). A deficient superior-posterior rim and pulmonary hypertension were associated with failure to close the defect (P = 0.02 and 0.03, respectively).
The majority of secundum atrial septal defect is amenable to transcatheter closure, using a modified implantation technique in 16% of cases.