Transcatheter closure of large atrial septal defects in children using the left atrial disc engagement–disengagement technique (LADEDT)—technical considerations and short term results

OBJECTIVE: To report our experience of transcatheter closure (TCC) of large atrial septal defects (ASDs) in children using the left atrial (LA) disc engagement-disengagement technique (LADEDT). METHODS: This is a retrospective study comprising 21 children diagnosed with large secundum ASDs. All of them had an attempt at TCC with the Amplatzer septal occluder (ASO) using LADEDT. They were assessed by clinical examination, ECG and echocardiography before the procedure, at 24 hours, 6 weeks, 6 months, and every 1 year after the device closure. RESULTS: The median age of the cohort was 3 years (range 1-12 years). The weight ranged from 5 to 40 kg (median = 12 kg). The mean ASD diameter was 16.7 ± 4.3 mm. The median device size used was 22 mm (range 15-40 mm). The device was successfully placed from the superior pulmonary vein (left: 12; right: 4) and the LA appendage (LAA) in 2. In three patients the technique failed and we had to resort to the balloon assisted technique (BAT) for a successful deployment. The number of attempts for deployment ranged from 1 to 4 (median 2). Despite appropriate placement, the device was not released in one patient because of deficient and floppy inferior margin. One patient had worsening of mitral regurgitation from mild to moderate grade without further progression till last follow up. There were no other major complications during the follow up (6.2 ± 2.4 months) period. CONCLUSION: TCC of large ASDs in small children using the LADEDT is predictable, reproducible, relatively simple, safe, and effective.