Key result
Erosion after transcatheter ASD closure requires surgery in ~90% of cases, linked to device oversizing.
Why the study?
Cardiac erosion following transcatheter secundum ASD closure is rare but life-threatening, and available evidence remains limited to isolated case reports and small series.
Aortic and aorto-atrial erosion after transcatheter secundum ASD closure is a rare but severe complication often associated with female sex, deficient retro-aortic rim, and device oversizing, typically requiring surgical repair.
Answers are grounded in this paper and cite their sources.
Heightens caution on oversizing in females; extends case data on erosion timing and surgical rates.
Background: Cardiac erosion after transcatheter closure of secundum atrial septal defect (ASD) is a rare (0.1–0.3%) but potentially life-threatening complication. Available evidence remains limited to isolated case reports and small case series. Methods: A case-based review was conducted in accordance with CABARET recommendations. PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception through January 2026. Adult cases with anatomically confirmed aortic or aorto-atrial erosion after transcatheter closure of a secundum ASD were included. Clinical, anatomical, procedural, imaging, management, and outcome data were synthesized descriptively. An illustrative case with aorto-atrial erosion was included. Results: A total of 40 cases, including the present case, were identified. Median age was 39.5 years, and 27 were female. Chest pain was the most common symptom, reported in 16 cases, whereas six patients were asymptomatic at diagnosis. Median time to erosion was 81 days (range, 0.25–4745 days). A deficient rim was reported in 22 patients, and device oversizing in 17 patients. All erosions involved the aortic wall, most frequently at the atrial roof adjacent to the non-coronary sinus. Aorta-right atrial and aorta-left atrial were the predominant anatomical patterns, reported in 21 and 14 patients, respectively. Surgical intervention was required in 36 cases, which consisted of device explantation with atrial and/or aortic repair. Conclusions: Aortic and aorto-atrial erosion after transcatheter secundum ASD closure is an uncommon but severe complication with heterogeneous clinical presentation and timing. Among published erosion cases, female sex, a deficient retro-aortic rim, device oversizing, and mild aortic root dilation were recurrent characteristics. Careful anatomical assessment, multimodality imaging, and continued follow-up remain essential for early recognition of cardiac erosions.
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Deaconu et al. (2026) conducted a review in Aortic or aorto-atrial erosion after transcatheter secundum ASD closure (n=40). Transcatheter closure of secundum ASD was evaluated on Clinical, anatomical, procedural, imaging, management, and outcome data of aorto-atrial erosion. Aortic and aorto-atrial erosion after transcatheter secundum ASD closure required surgical intervention in 36 of 40 cases, with female sex and device oversizing as recurrent characteristics.
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