Transcatheter Closure of Atrial Septal Defect with Amplatzer Device in Children and Adolescents: Short and Midterm results; an Iranian Experience

Objective: Transcatheter closure of secundum atrial septal defect (ASD) with Amplatzer device is an alternative procedure to surgical repair, with some limitations. The aim of this study was to assess the initial and mid-term results of the treatment of ASD with Amplatzer septal occluder in children and adolescents. Methods: From May 2003 to January 2008 sixty three consecutive children and adolescent patients underwent transcatheter closure of ASD at a mean +/- SD age of 8.5 +/- 4.8 years (range 2.2 to 18 years). All procedures were performed under local anesthesia and moderate sedation or general anesthesia with transthoracic echocardiography and fluoroscopic guidance. Stretch diameter of ASD was determined by balloon sizing catheter. Device selection was based on and matched to the standard diameter of the septal defect. Follow up at 24 hours, 1 month, 6 months, 12 months and yearly thereafter included physical examination, electrocardiography and transthoracic echocardiography. Findings: The mean ASD diameter, measured with transthoracic echocardiography and balloon catheter were 19.5 +/- 5.5 mm and 20.9 +/- 6.2 mm, respectively. The mean follow up period was 32.4 +/- 18.8 months. Deployment of the device was successful in 57 (90.5%) and failed in 6 (9.5%) patients. The major complication included dislodgement of device in 1 patient and device embolization to right ventricular inlet (surgically removed) in 1 patient. The minor complication included transient atrial tachycardia in 10 patients, paroxysmal supraventricular tachycardia in 2 patients during procedure, successfully terminated with medication. At 24 hour, 1 month, 6 month and 1 year follow up, total occlusion rates were 73.6%, 91%, 94.7%, and 94.7%, respectively. Conclusion: Transcatheter occlusion of ASD with Amplatzer device is an effective and safe procedure with minimal complication rate and short hospital stay, as well as excellent short and intermediate outcome in children and adolescents.