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Intermediate and long-term followup of percutaneous device closure of fossa ovalis atrial septal defect by the Amplatzer septal occluder in a cohort of 529 patients.

Tomar M, Khatri S, Radhakrishnan S, Shrivastava S - Ann Pediatr Cardiol (2011)

Bottom Line: Interventricular septal motion normalized on day of procedure in 89% patients, in 6% over 3 months while flat septal motion persisted in 5% (n=25, all in age group > 40 years) of cases, though right ventricular dilatation persisted in 10% (n=50, age more than 40 years) of patients.Symptom-free survival was 96.7 % (480/496) in patients who came for followup.Only one 68 year old patient with preexistent tricuspid regurgitation developed congestive heart failure, and one patient (58 years old) had a history of hemiparesis after 1 year of device on telephonic interview.

View Article: PubMed Central - PubMed

Affiliation: Department of Congenital and Pediatric Heart Diseases, Fortis Escorts Heart Institute, New Delhi, India.

ABSTRACT

Objectives: The aim of present study is to analyze the intermediate and long-term follow up results of percutaneous closure of fossa ovalis atrial septal defect (ASD) with Amplatzer septal occluder (ASO) in a large cohort of patients including children and adults.

Methods: Between May 1998 and July 2008, 529 patients (age group 2-77 years, median 28 years) underwent successful device closure with an ASO at single tertiary referral cardiac center in India.. This was out of an attempted 543 cases. The procedure was carried out in catheterization laboratory under transesophageal echocardiographic and fluoroscopy guidance. The mean size of ASD was 20 mm (7-40 mm) while size of septal occluder was 10-40 mm (mean 24 mm). Two devices were deployed in four patients. Three patients developed transitory pulmonary edema in immediate postprocedure period requiring ICU care for 48 hrs. All patients were advised for Aspirin (3-5 mg/kg, maximum 150 mg) once daily for 6 months. In patients with device 30 mm or larger, Clopidogril ( 75 mg once daily) was given for 3 months in addition to Aspirin. Clinical evaluation, echocardiogram were done on 3 months, 6 months and then at 1, 3, 5, 7 and 10 years of follow up. Transesophageal echocardiography (TEE) was performed in case of any doubt on clinical evaluation or on transthoracic echocardiography (n=10).

Results: Followup data is available for 496 patients (93.7%). Followup period is from 12 months to 120 months (median 56 months). On followup, device was in position in all patients, no residual shunt and no evidence of thrombosis. Interventricular septal motion normalized on day of procedure in 89% patients, in 6% over 3 months while flat septal motion persisted in 5% (n=25, all in age group > 40 years) of cases, though right ventricular dilatation persisted in 10% (n=50, age more than 40 years) of patients. Symptom-free survival was 96.7 % (480/496) in patients who came for followup. Only one 68 year old patient with preexistent tricuspid regurgitation developed congestive heart failure, and one patient (58 years old) had a history of hemiparesis after 1 year of device on telephonic interview. Ten patients were in atrial fibrillation (AF) before the procedure and remained in AF on followup.

Conclusions: Our study showed that percutaneous closure of fossa ovalis ASD is a safe and effective procedure on intermediate and long-term followup in both the children as well as adults.both. Technical factors during the procedure and proper follow up are important. Our single centre intermediate and long term experience in a large number of patients support the use of device closure as an alternative to surgery.

No MeSH data available.


Related in: MedlinePlus

The distribution of ASD size (2a), and the device size (2b), in the patient population
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Figure 2: The distribution of ASD size (2a), and the device size (2b), in the patient population

Mentions: The procedure was done in catheterization laboratory under general anesthesia with TEE and fluoroscopy guidance. The protocol for device implantation is same as described in literature.[1213] In period prior to November 2003, our institute policy was to use balloon stretch diameter (Equalizer™ Occlusion Balloon Catheter, Boston Scientific) for selecting the device size. With this technique, ASD size and device size ratio was 1.5-1.7. Since December 2003 till 2006, we were taking balloon occlusion diameter (Amplatzer sizing balloon) to select the device and ASD size and device ratio was 1.2:1.4. Since 2007, our policy is to take device 2 mm larger than defect if all the rims are adequate or 2-4 mm larger than defect if 1 or more rim(s) is deficient. The ASD size and device ratio remained between 1.2 and 1.4 with this policy. The mean diameter of ASD was 20 mm (range 7-40 mm) and required device sized 24 (range 10-40mm) [Figure 2a–b].


Intermediate and long-term followup of percutaneous device closure of fossa ovalis atrial septal defect by the Amplatzer septal occluder in a cohort of 529 patients.

Tomar M, Khatri S, Radhakrishnan S, Shrivastava S - Ann Pediatr Cardiol (2011)

The distribution of ASD size (2a), and the device size (2b), in the patient population
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104526&req=5

Figure 2: The distribution of ASD size (2a), and the device size (2b), in the patient population
Mentions: The procedure was done in catheterization laboratory under general anesthesia with TEE and fluoroscopy guidance. The protocol for device implantation is same as described in literature.[1213] In period prior to November 2003, our institute policy was to use balloon stretch diameter (Equalizer™ Occlusion Balloon Catheter, Boston Scientific) for selecting the device size. With this technique, ASD size and device size ratio was 1.5-1.7. Since December 2003 till 2006, we were taking balloon occlusion diameter (Amplatzer sizing balloon) to select the device and ASD size and device ratio was 1.2:1.4. Since 2007, our policy is to take device 2 mm larger than defect if all the rims are adequate or 2-4 mm larger than defect if 1 or more rim(s) is deficient. The ASD size and device ratio remained between 1.2 and 1.4 with this policy. The mean diameter of ASD was 20 mm (range 7-40 mm) and required device sized 24 (range 10-40mm) [Figure 2a–b].

Bottom Line: Interventricular septal motion normalized on day of procedure in 89% patients, in 6% over 3 months while flat septal motion persisted in 5% (n=25, all in age group > 40 years) of cases, though right ventricular dilatation persisted in 10% (n=50, age more than 40 years) of patients.Symptom-free survival was 96.7 % (480/496) in patients who came for followup.Only one 68 year old patient with preexistent tricuspid regurgitation developed congestive heart failure, and one patient (58 years old) had a history of hemiparesis after 1 year of device on telephonic interview.

View Article: PubMed Central - PubMed

Affiliation: Department of Congenital and Pediatric Heart Diseases, Fortis Escorts Heart Institute, New Delhi, India.

ABSTRACT

Objectives: The aim of present study is to analyze the intermediate and long-term follow up results of percutaneous closure of fossa ovalis atrial septal defect (ASD) with Amplatzer septal occluder (ASO) in a large cohort of patients including children and adults.

Methods: Between May 1998 and July 2008, 529 patients (age group 2-77 years, median 28 years) underwent successful device closure with an ASO at single tertiary referral cardiac center in India.. This was out of an attempted 543 cases. The procedure was carried out in catheterization laboratory under transesophageal echocardiographic and fluoroscopy guidance. The mean size of ASD was 20 mm (7-40 mm) while size of septal occluder was 10-40 mm (mean 24 mm). Two devices were deployed in four patients. Three patients developed transitory pulmonary edema in immediate postprocedure period requiring ICU care for 48 hrs. All patients were advised for Aspirin (3-5 mg/kg, maximum 150 mg) once daily for 6 months. In patients with device 30 mm or larger, Clopidogril ( 75 mg once daily) was given for 3 months in addition to Aspirin. Clinical evaluation, echocardiogram were done on 3 months, 6 months and then at 1, 3, 5, 7 and 10 years of follow up. Transesophageal echocardiography (TEE) was performed in case of any doubt on clinical evaluation or on transthoracic echocardiography (n=10).

Results: Followup data is available for 496 patients (93.7%). Followup period is from 12 months to 120 months (median 56 months). On followup, device was in position in all patients, no residual shunt and no evidence of thrombosis. Interventricular septal motion normalized on day of procedure in 89% patients, in 6% over 3 months while flat septal motion persisted in 5% (n=25, all in age group > 40 years) of cases, though right ventricular dilatation persisted in 10% (n=50, age more than 40 years) of patients. Symptom-free survival was 96.7 % (480/496) in patients who came for followup. Only one 68 year old patient with preexistent tricuspid regurgitation developed congestive heart failure, and one patient (58 years old) had a history of hemiparesis after 1 year of device on telephonic interview. Ten patients were in atrial fibrillation (AF) before the procedure and remained in AF on followup.

Conclusions: Our study showed that percutaneous closure of fossa ovalis ASD is a safe and effective procedure on intermediate and long-term followup in both the children as well as adults.both. Technical factors during the procedure and proper follow up are important. Our single centre intermediate and long term experience in a large number of patients support the use of device closure as an alternative to surgery.

No MeSH data available.


Related in: MedlinePlus