AIM
To assess feasibility of percutaneous treatment of multiple ASDs.
Methods. Between 1998 and 2007, 165 out of 1280 consecutive patients undergoing ASD percutaneous closure at our institution showed multiple defects. According to the septum anatomy and the clinical characteristics multiple ASDs were classified in four categories: double atrial septal defects (d-ASD), multi-fenestrated atrial septal defects (f-ASD), multi-fenestrated defects with no signs of right heart overload (f-PFO), and complex cases (c-ASD). End-points were: 1) immediate procedural success; 2) long term safety and efficacy.
Results. In this study, up to 81% of multiple ASDs was suitable for percutaneous closure. Accurate ASD morphology assessment and appropriate device selection were key elements to obtain procedural success. Multiple device implantations were required in 47% of cases, especially in patients with d-ASD and c-ASD. Complication rate, residual shunt and long term outcome were comparable among the four different categories. In particular, at long term follow-up (6 ± 1.8 years) no patient required further surgical or percutaneous treatment and complete closure was confirmed in 98% of cases.
Conclusions. Percutaneous closure of multiple ASDs is feasible and associated with a good outcome. A thorough identification and analysis of morphological aspects are mandatory in order to select the appropriate device and the optimal strategy. The implantation of multiple devices does not seem to be associated to an increased risk of complications at long term follow up.