Key result
In patients undergoing transcatheter closure of large atrial septal defects, the need for modified deployment methods was associated with a significantly shorter anterosuperior rim (p<0.05).
Why the study?
What morphologic characteristics predict the need for technical modification during transcatheter closure of large atrial septal defects?
Observational (n=109)
No
What morphologic characteristics predict the need for technical modification during transcatheter closure of large atrial septal defects?
p-value: p=<0.05
Anterosuperior rim deficiency and larger ASD size predict the need for modified deployment techniques during transcatheter closure of large atrial septal defects.
May inform procedural planning for large ASD closure; extends anatomic predictors but leaves open prospective validation.
BACKGROUND AND OBJECTIVES: The rigid coupling between the delivery wire and the right atrial disk has been occasionally encountered during transcatheter closure of atrial septal defect (ASD). Therefore the device frequently makes a perpendicular angle, and the leading edge of left atrial disk slips through the defect and prolapses into right atrium (RA) before it is properly placed in the septum. The purpose of this study is to investigate relating factors to the need of technical modification in transcatheter closure of large ASD and to evaluate relevant morphologic characteristics of atrial septal rim in this situation. SUBJECTS AND METHODS: From July, 2003 to May, 2007, 312 patients underwent transcatheter occlusion of ASD with Amplatzer Septal Occluder(R) (ASO, AGA medical corporation, Golden Valley, MN, USA) at Yonsei Cardiovascular Center and among them 109 patients had large ASD (>/=25 mm) and these patients were enrolled in our study. Patients were divided into two groups according to the deploying methods of the device (Group I: standard method, Group II: modified methods). Assessments of the defects and its surrounding rims were made by echocardiography. RESULTS: There were no differences between 2 groups in age, body weight and height except for balloon-stretched diameter (stop-flow technique) and device size. Group II patients with modified methods showed larger balloon-stretched diameter and device size than group I patients with standard method. The mean length of anterosuperior (AS) rim in group II was significantly shorter than group I (p<0.05). As the size of the device used in procedure increased, there was a trend towards increase in the need of modified methods. CONCLUSION: This study shows that AS rim deficiency and the size of ASD may be the relating factors to the need of technical modification in transcatheter closure of ASD. Therefore, when the initial try with standard method is not successful in large ASD with deficient AS rim, we suggest that changing strategy of implantation may save time and efforts and possibly reduce the risk of complications associated with prolonged procedure.
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Park et al. (2010) conducted an observational in Large atrial septal defect (≥25 mm) (n=109). Modified deployment methods vs. Standard deployment method was evaluated on Mean length of anterosuperior (AS) rim (p=<0.05). In patients undergoing transcatheter closure of large atrial septal defects, the need for modified deployment methods was associated with a significantly shorter anterosuperior rim (p<0.05).
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