Closure of large atrial septal defects(ASD)continue to pose problems for percutaneus closure.We report our learning experience of 106 procedures in patients age 12.8years(±8.99),using Amplatzer Septal occluder(ASO)
Methods :
ASO was used in all cases.General anaestesia used with transoesophageal echocardiography.Sizing Balloon used to size all ASD initially but lately to size only those with variable diameters in various echo views
Results :
ASD size was 24.23 mm(±6.11)either with sizing balloon or colour Doppler.Device size was 27.86mm(±7.44).Two had multiple ASD,one had aneurysm of IAS with multiple ASD,each closed with one device.Two devices were used in 2 and 1 deployment was unsuccesful.Did not attempt device closure in 5.3 had IVC and superior rims deficient,2 due to ASD too large for 5 and 6 years old. Used Balloon assisted (BAT) in 8 and catheter assisted technique(CAT )in 2 with small inferior or superior rims.Deployed part of LA disk in RUPVorLUPV with deployement of RA disk in RA and then pulled the LA disk for large ASD. One patient had PDA ,closed by coil,3 had pulmonary valvoplasty for pulmonary stenosis simultaneously
Major complication was pericardial effusion in 1, developed after 3 days required pericardiocentesis. Minor complications were transient AV block type II in 1,SVT in 1 complete heart block in 1.
Conclusions :
We conclude that large ASD continue to be a challenge in selection , deployment and procedure time. Complication were seen in large ASD. For us cost issue makes use of more than 1devices prohibitive,and a greater stress in sizing and device selection