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Pediatr Cardiol. 2020 Feb 1. doi: 10.1007/s00246-020-02288-0. [Epub ahead of print]

Long-Term Follow-Up of Transthoracic Echocardiography-Guided Transcatheter Closure of Large Atrial Septal Defects (≥ 30 mm) Using the SHSMA Occluder.

Author information

1
Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China.
2
Department of Ultrasonography, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China.
3
Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 Lanxi Rd, Shanghai, 200062, China.
4
Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China. smmulipan@163.com.
5
Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China. cxcardio@163.com.
6
Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China. 13764924032@163.com.

Abstract

Transcatheter closure of large atrial septal defects (ASDs) remains controversial. The aim of this study was to evaluate the feasibility and safety of transthoracic echocardiography (TTE)-guided transcatheter closure of large ASDs. Patients with large secundum ASDs (≥ 30 mm) who underwent device closure were retrospectively reviewed. TTE was performed to guide ASD occluder positioning and assess the immediate and long-term outcomes. A total of 60 patients (median age 43.5 years, range 15-78 years) were enrolled in the study. The median ASD size was 35 mm (range 30-42 mm). Mild to moderate pulmonary hypertension was observed in 36 patients (60%). Thirty-one patients (51.7%) had one short rim, and 18 patients (30.0%) had two deficient rims. Placement of the device was successful in 57 patients (95%), and the median device size was 42 mm (range 40-50 mm). Dislodgement of the device occurred in three patients with two deficient rims: a larger device was redeployed in one case, and two patients required surgical repair. During a median follow-up of 37 months (range 6-83 months), no residual shunts, erosion, or embolization were noted, and pulmonary hypertension resolved in 75% of the patients. Thus t vast majority (95%) of large ASDs can be successfully closed percutaneously using the Chinese-made Shanghai Shape Memory Alloy (SHSMA) occluder under TTE guidance. Long-term follow-up showed that transcatheter closure could become a safe and effective alternative to surgery in select large ASDs.

KEYWORDS:

Atrial septal defect; Congenital heart disease; Percutaneous intervention; Transcatheter closure

PMID:
32006083
DOI:
10.1007/s00246-020-02288-0

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