Morphologic Characteristics & Relating Factors to the Need of Technical Modification in Transcatheter Closure of Large Atrial Septal Defect (¡Ã 25mm)
Yonsei University Shinchon Severance Hospital, Seoul, Korea (Republic of)
N.K. Kim, H.S. Kwon, B.W. Yoo, J.Y. Choi, J.H. Sul
Background: The AGA Amplatzer delivery system has a rigid coupling between the delivery wire and the right atrial disk. So the device frequently make perpendicular angle, and the leading edge of LA disk slip through the defect and prolapse into RA before it is properly placed in the septum. Many technical modifications to solve this problem have been developed. The purpose of this study is to investigate relating factors to the need of technical modification in transcatheter closure of large ASD and to evaluate morphologic characteristics of atrial septal rim in this situation.
Methods: From July, 2003 to May, 2007, 312 patients underwent transcatheter occlusion of ASD with Amplatzer Septal Occluder at Yonsei cardiovascular center. Among them, 35% of patients have large ASD more than 25 mm. These 109 patients were enrolled in this study. Patients were divided into two groups according to the deploying methods of the device. Assessments of the defects and its surrounding rims were based on transesophageal or intracardiac echocardiography performed at the time of closure. Any rim length was considered deficient if its length was less than 5 mm.
Results: There were no differences between 2 groups in age, body weight and height except for balloon occlusive diameter and device size. Group II patients with modified methods showed larger Balloon occlusive diameter and device size than group I patients with standard method. The mean length of anterosuperior rim in group II was significantly shorter than group I (P<0.05). As a size of the device used in procedure increase, modified methods were needed more frequently.
Conclusion: This study shows that AS rim deficiency and the size of ASD may be the relating factors to the need of technical modification in transcatheter closure of ASD. So when the initial try with standard method is not successful in large ASD with deficient AS rim, we suggest that changing strategy of implantation may save time and efforts and possibly reduce the risk of complication by prolonged procedure.
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