This document summarizes the results of percutaneous closure of atrial septal defects (ASDs) in patients. It finds that: 1) Transcatheter closure is now the treatment of choice for most ASD Type II cases, with over 90% able to be closed this way. 2) The author's center has performed over 1,000 ASD closures since 1997, mostly using the Amplatzer device, with low rates of complications like embolization. 3) While generally safe, complications like erosion of the atrial wall are still possible even after months and close follow-up is needed after the procedure.

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Jacek Białkowski
Silesian Center for Heart Diseases, Zabrze, Poland
Peripheral Interventions Workshop,
8, May 2014 , Kraków

2. ASD types -90% ASD II

3. TRANSCATHETER ASD CLOSURE
 The first report - transcatheter ASD closure
(King, JAMA 1976)
 Mile stone - Amplatzer Occluders (ASO)
(Masura, CCI 1997)
 70-80 % ASD II can be closed with transcatheter methods
(Podnar,CCI 2001)
Method of choice in our center from 1997

4. ASD II CLOSURE
oPercuatneous ASD closure - method of choice
(according to ESC guideline 2010)
oIndications – RV dilatation (ECHO) or history
of cryptogenic stroke
oNitinol mesh devices are prefered for ASD
closure

5. Nitinol wire mesh device (invented by dr Kurt Amplatz)
composed of two disc

6. Opening of ASO

7. ASD- OWN EXPERIENCE
Percutaneous ASD closure since 1997
 Total number of pts (till june. 2013) 1171
• Amplatzer 979
(83,6%)
• Figulla 83 (7,8%)
• Chinese 60 (5,1%)
• CardioSEAL (withdrawn 2012) 50
• Helex 2

8. Transcatheter ASD closure
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9. Relation of ASD to sorrounding structures

10. TRANSCATHETER ASD CLOSURE
LOCALIZATION OF THE DEFECT
(ACCORDING OWN MATERIAL)
A) Central (56%)
B) Without aortic rim
(42%)
C) Posterior (2%)

11. ZZeessppóółł rrssRR′′ ww VV11-- oobbee-ccnnyy ww 9900%% AASSDD IIII

12. TRANSCATHETER ASD CLOSURE
PROCEDURAL STEPS
GA (children), diagnostic
catheterization and TEE
Implantation
and repeat TEE
Balloon sizing
(omitted in 363 pts)

13. TRANSCATHETER ASD CLOSURE
BALLOON CALIBRATION
 Generally crucial for choosing device size
 Prefered balloon „stop flow” method , BUT
 Omitted in 363 pts
 with large ASD
 central ASD with stable rims
 multifenestrated septum
in small children (too long balloons)

14. „CLOSURE OF ASD WITH AMPLAZTZER SEPTAL
OCCLUDER IN ADULTS” Majunke, Bialkowski , Am J Cardiol 2009
Nr of patients 650
 Single / Double ASD 572/78
 Nr of pts > 60 y old 153
 Results in pts >60y and<60 y similar
 Embolization 6 (2 early)
 Hemopericardium (erosion) 2
 LV heart failure 4

15. TRANSCATHETER ASD II CLOSURE
COMPLICATIONS
Data of AHA(Circ. 2011) Own exp.
• embolization 1,1% 0,7%
• erosion/tamponade 0,1% 0,1%
• A/V blok (pacemaker) 0,3% 0,1%
• Thrombus formation 0,7% 0%
• TIA 0,2% 0,1%
• Arrhythmia 3,8% 1,2%

16. EROSION OF ARIAL WALL
 Possible even after few months
 in AGA registry 0,1%
 higher risk in ASD without Ao rim and using oversized
devices
 Follow-up with TTE is mandatory

17. RISK FOR EROSION WITH ASO
A) INTERMITTENT CONTACT; B) SPLAYING ; C) PROTRUSION ; D) MOTION

18. ASD II – RHYTHM DISTURBANCES
New symptomatic tachyarrythmias usually
sporadically during 3 months after the
procedure – 9/738 pts (1,3%) – usualy older pts
 SVT in 1 pts (farmacologic treatment)
 AF in 8 pts (electroshock), BUT….
Complete a-v block in 2 pts (15 and 16 y old - 4,3 and 1,5 y
after procedure rescpectively ) - pacemaker
•Szkutnik, Bialkowski et al. „Symptomatic tachy and
bradyarrhytmias after transcatheter closure of ASD with Amplatzer
devices”. Cardiol J 2008

19. Holter ECG intermittent III deg a-v
block with pauses up to 7 sec

20. C O N C L U S I O N
Transcatheter ASD closure is effective and
safe method, when performed by experienced
interventionalist. Severe complications are rare
and long – term results exelent.
Close follow-up of this pts is mandatory
Excellent cooperation with echocardio-graphist
is obligatory