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Impact of modified techniques of transcatheter closure in large atrial septal defects (⩾30 mm) with anatomic complexities

Published online by Cambridge University Press:  23 July 2018

Ajith Ananthakrishna Pillai Open the ORCID record for Ajith Ananthakrishna Pillai [Opens in a new window] ,
Amarnath Upadhyay ,
Saranya Gousy  and
Amit Handa
Ajith Ananthakrishna Pillai*
Affiliation:
Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
Amarnath Upadhyay
Affiliation:
Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
Saranya Gousy
Affiliation:
Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
Amit Handa
Affiliation:
Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry, India
*
Author for correspondence: A. A. Pillai, Additional Professor, Department of Cardiology, Jawaharlal Institute of Post-Graduate Medical Education and Research, Puducherry 605006, India. Tel: +91 9488828946; Fax: +91 4137199; E-mail: ajithanantha@yahoo.com
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Abstract

Objective

The outcome of transcatheter closure in ostium secundum atrial septal defects is determined by the morphology of the defects. Modified techniques such as balloon assistance, pulmonary vein deployment, left atrial roof technique, and so on are used for circumventing the anatomic complexities and increasing the success rates.

Methods

We planned a prospective study looking at the outcomes of transcatheter closure in secundum atrial septal defects with modified techniques in different anatomic complexities identified in transoesophageal echocardiography and their association with outcome of transcatheter closure.

Results

Transcatheter closure was successful in 295 out of 346 (82%) patients with modified techniques. Balloon-assisted technique offered a success rate of 87%. The mean defect size was 34.7±2.78 mm (95% confidence interval (CI) 30.67–43.1 mm) with success and 40.16±4.5 mm (95% CI 32.16–44.7) with failure (p = 0.02). The mean total septal length was 38.11±0.63 (95% CI 35.21–40.56 mm) with success and 42.54±0.34 (95% CI 38.79–43.21 mm) with failure. The defect to septal ratios were 0.82 and 0.94 in success and failure groups, respectively (p=0.02). However, the absence of a retro-aortic margin, septal aneurysm, and multiple defects did not affect the success rate. Deficient inferior vena caval margin, deficient posterior margin, and size⩾40 mm had a high risk of failure with transcatheter closure. The odds ratio for procedural failure was 25.3 (4.3–143.8) in patients with malaligned septum, 8.3(1.4–48.5) with deficient inferior vena caval margin, and 4.1(2.5–19) for size⩾40 mm.

Conclusions

The modified techniques for device deployment offer substantial chances of success in transcatheter closure of secundum atrial septal defects with anatomical complexity (82%). Variants such as defect size of⩾40 mm and deficient inferior and posterior margins have high failure rates with a modified technique.

Keywords

Inter-atrial septummorphologyatrial septal defectseptal malalignmentdevice closure
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 10 , October 2018 , pp. 1122 - 1133
Copyright
© Cambridge University Press 2018 

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