Intra-operative device closure of multiple atrial septal defects facilitated by a unique atrial septum remodeling technique: initial results and experience in 11 patients

We introduced a new atrial septum remodeling technique and further investigated the feasibility of this method in facilitating the intra-operative device closure (IODC) of multiple atrial septal defects (ASDs). Adult patients with multiple nearby ASDs, which were not eligible for transcatheter closure, were enrolled in this study. Transesophageal echocardiogram (TEE) was applied for intra-operative evaluation. The multiple ASDs were divided into three different types according to its morphology. Based on the concept of breaking the rim between multiple ASDs and making it feasible for single device closure, atrial septum remodeling procedure was carried out via pre-atrial approach using special clamp under the guidance of TEE. IODC was then attempted for reshaped ASD. Successful rate and perioperative complications were then noted. Eleven patients were enrolled in this study, with mean age being 23.4 +/- 5.3 years and mean weight 51.6 +/- 8.0 kg. Among them, seven patients have double ASDs and four have triple ASDs. Mean diameter of isolated ASD was 10.4 +/- 3.8 mm with a mean distance of 3.2 +/- 1.2 mm between each other. Atrial septum remodeling procedure was successfully done in all patients. One device was then used for each patient. Mean ASD diameter after remodeling procedure was 20.6 +/- 3.9 mm with mean device size 23.5 +/- 4.0 mm. Complete closure of multiple ASDs was achieved in nine patients immediately after the procedure; two patients had trivial grade shunt after device deployment that resolved within the 3-month follow-up. No severe complications were noticed during the perioperative period and the 3-month follow-up. Atrial septum remodeling technique seems to be a safe and effective method that could largely facilitate the successful IODC of multiple ASDs.