Percutaneous closure of atrial septal defects (ASD) is a safe alternative to surgery. We undertook a study to evaluate how the learning curve and experience has affected percutaneous ASD closure in our centre.
Methods
Ninety two patients underwent attempted percutaneous closure of ASDs over last 5 years. There were 38 males. Patients were divided into 2 groups “A” (initial 2 ½ years) and “B” (subsequent 2 ½ yrs) representing early and late experience of the operator. There were 35 patients in group A and 57 patients in group B.
Results
The mean age in group A was 29±14 (range 8-56yrs) and 17±11 yrs (range 0.5-54yrs) in group B. The mean size of the ASD on transesophageal echocardiogram was 20±8 mm in group A and 22±12mm group B (p=0.03). Mean QP/QS in group A was 2.1±0.8 and 2.7±1.8 in group B. Balloon sizing was done in all patients in group A and 24 patients in group B. Ratio of device size to TEE size of defect was 1.45±0.2 in group A and 1.2±0.08 (p=0.04). There were failure of device placement in 2 patients in Group A and 3 in group B. Device embolization occurred in 2 patients in group B and none in group A. Atrial fibrillation occurred in 3 patients in Group A and 1 in Group B.
Conclusion
Our study showed closure of larger ASDs, younger patient age and use of relatively smaller device to defect ratio with experience. Embolizations were seen only in group B.