Amplatzer septal occluder-associated cardiac perforation uniquely involves the anterosuperior atrial walls and adjacent aorta, with 66.6% of events occurring late (post-discharge).
Observational (n=24)
Yes
Cardiac perforation after ASD closure with the Amplatzer septal occluder is a rare but serious complication that often occurs late (post-discharge) and predominantly involves the anterosuperior atrial walls and adjacent aorta.
OBJECTIVES: Amplatzer septal occluder (ASO)-associated cardiac perforation (CP) at our institution prompted this retrospective review. BACKGROUND: Cardiac perforation is a rare complication after transcatheter atrial septal defect (ASD) closure. METHODS: To identify CP after transcatheter ASD closure with ASO, cardiac events (CE) describing definite CP, hemopericardium, pericardial effusion, cardiovascular collapse, or sudden death were analyzed. Cardiac events were identified from published literature (MEDLINE), medical device regulating agencies in North America and the European Commission, and AGA Medical Corporation (Golden Valley, Minnesota). Institutional cases were reviewed. Cardiac events were defined as early (pre-discharge) or late (post-discharge). RESULTS: Twenty-nine CEs were identified. Five were excluded because findings were inconclusive for device-related CP. Ten patients were <18 years of age. Late CEs occurred in 66.6%; 25% presented weeks later (longest, three years). Three deaths were reported. Cardiac perforation occurred predominantly in the anterosuperior atrial walls and/or adjacent aorta. CONCLUSIONS: Amplatzer septal occluder-associated CP uniquely involves the anterosuperior atrial walls and adjacent aorta. Pathophysiology remains poorly understood.
“Nonetheless, we think there should be some re-assessment in terms of doing re-analysis of the data, with 2 points in mind. The first is going back to the drawing board and having a broader view, not focusing so carefully on the anatomy, which would seem to be the most likely explanation, but to consider other factors in this re-analysis.”
Divekar et al. (Fri,) conducted a observational in Atrial septal defect (n=24). Amplatzer septal occluder (ASO) was evaluated on Characteristics and timing of cardiac perforation events. Amplatzer septal occluder-associated cardiac perforation uniquely involves the anterosuperior atrial walls and adjacent aorta, with 66.6% of events occurring late (post-discharge).
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