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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

Number of patients and their maximum follow up period
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Figure 3: Number of patients and their maximum follow up period

Mentions: Followup data is available for 496 (93.7%) patients [Figure 3], period 12 months -120 months (median 56 months). Of these 496 patients, 10 patients did not come for followup but were evaluated at local center and details were available on phone/fax. Clinically all patients were in NYHA class 1 except two. This 68-year-old lady with fossa ovalis ASD (18 mm), left to right and moderate tricuspid regurgitation underwent device closure (24 mm) after balloon occlusion test to look for any rise in right atrial pressure. She was discharged on diuretics and was stable on 1 month followup. On 3 months followup she was in right-sided failure with respiratory distress, hepatomegaly and pedal edema. She was stabilized after increasing the dose of diuretics. Twenty patients developed headache after device deployment, nine were having pre-existing migraine while in 11 patients headache developed de novo. On followup headache was not persistent and also there was no further worsening of migraine episodes. A 58-year-old female patient (ASD 17 mm, device 24 mm) developed hemiparesis 1 year after the procedure. At the time of discharge she was in normal sinus rhythm and was discharged on asprin. As she did not come for followup, she was contacted telephonically. No cardiology or neurologic evaluation was done to look for the cause of hemiparesis.


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)

Number of patients and their maximum follow up period
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Number of patients and their maximum follow up period
Mentions: Followup data is available for 496 (93.7%) patients [Figure 3], period 12 months -120 months (median 56 months). Of these 496 patients, 10 patients did not come for followup but were evaluated at local center and details were available on phone/fax. Clinically all patients were in NYHA class 1 except two. This 68-year-old lady with fossa ovalis ASD (18 mm), left to right and moderate tricuspid regurgitation underwent device closure (24 mm) after balloon occlusion test to look for any rise in right atrial pressure. She was discharged on diuretics and was stable on 1 month followup. On 3 months followup she was in right-sided failure with respiratory distress, hepatomegaly and pedal edema. She was stabilized after increasing the dose of diuretics. Twenty patients developed headache after device deployment, nine were having pre-existing migraine while in 11 patients headache developed de novo. On followup headache was not persistent and also there was no further worsening of migraine episodes. A 58-year-old female patient (ASD 17 mm, device 24 mm) developed hemiparesis 1 year after the procedure. At the time of discharge she was in normal sinus rhythm and was discharged on asprin. As she did not come for followup, she was contacted telephonically. No cardiology or neurologic evaluation was done to look for the cause of hemiparesis.

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