The Influence of Morphological Changes in Amplatzer Device on the Atrial and Aortic Walls Following Transcatheter Closure of Atrial Septal Defects

Objective: This study prospectively investigated morphological changes in Amplatzer Septal Occluder (ASO) over time and the influences of these changes on the atrial and aortic walls after atrial septal defect (ASD) closure. Methods: Between August 2005 and December 2007, 78 patients with ASD were treated with ASO devices and changes in the device shape, the device thickness, and relations of the discs to the atrial and aortic walls over time were evaluated by transesophageal echocardiography immediately and 3-12 months after deployment. Results: The maximum unstretched ASD diameter was 16.2 +/- 4.8 mm and the device diameter selected was 20.6 +/- 5.5 mm. At the time of last follow-up, the device thickness decreased by 17-33%, 6 of 26 devices with a flare shape on the aortic side developed a closed shape, and the relations of the discs to the anterior atrial and aortic walls changed from touching to intermittent compression in 14 of the 78 cases. In these 14 cases, the aortic rim was significantly smaller, the number of flared device shapes on the aortic side/the number of closed shapes immediately after deployment was significantly larger, and the maximum device thickness at the middle part was significantly more decreased than those in other cases. Conclusion: As the device becomes thinner, loses its flexibility, and often changes from a flare-to-closed shape on the aortic side over time, the edges of ASO can start to compress the atrial and aortic walls. However, erosion was not recognized in these cases. (J Interven Cardiol 2009;22:83-91).