Open Access

ARTICLE

Safety and Efficacy of Transcatheter Closure of Atrial Septal Defects in Everyday Practice. A Multicenter Study in a Developing Country

by Amira Nour^1,*, Heba Kamel¹, Yasmeen Abdelrazik¹, Khaled Shams², Noha Gamal³, Safaa Huessin⁴, Alaa Roushdy¹, Maiy El Sayed¹

1 Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University, Cairo, Egypt
2 Congenital and Structural Heart Disease Unit, Cardiology Department, Helwan University, Cairo, Egypt
3 Cardiology Department, Assuit University, Assuit, Egypt
4 Pediatric Department, Sohag University, Sohag, Egypt

* Corresponding Author: Amira Nour. Email:

Congenital Heart Disease 2020, 15(2), 79-87. https://doi.org/10.32604/CHD.2020.011249

Received 28 April 2020; Accepted 11 June 2020; Issue published 23 June 2020

Abstract

Background: Transcatheter closure of secudum atrial septal defect (ASD) has gained wide acceptance since its introduction more than 3 decades ago. Safety and efficacy of the procedure in everyday practice needs continuous update. Objective: The aim of the study is to determine the incidence of complications and identify everyday management protocols. Methods: This is a prospective nonrandomized study including all the patients with Secundum ASD or fenestrated IAS referred to two different congenital heart diseases centers in Ain Shams university and sohag university in Egypt over 2 years with an indication for closure according to American and European guidelines. A custom-made sheet was made to include all relevant demographic and procedural data as well as any intra or periprocedural complications. Results: This study evaluated 330 patients over a period of 2 years. Most of the patients were in pediatric age group where the mean age was 12 +/– 13 years, mean weight of 40 +/– 15 kg, the mean device diameter used was 20 +/– 7.7 mm. The procedure was successful in 326, four patients required 2 simultaneous devices, and another three adult patients underwent simultaneous percutaneous coronary intervention (PCI). There were 26/330 (7.7%) complications, only one was life threating complication (0.3%); a LA appendage perforation which was managed surgically. The remaining complications were either major or minor, the most common was arrhythmia in 7 patients (2.3%), followed by device embolization in 5 patients (1.5%) all of them were retrieved percutaneously except one which was removed surgically. Four patients (1.2%) developed thrombus either on the right atrial side or LA side or both, managed successfully by anti-coagulation, similarly another four patients (1.2%) had pericardial effusion +/– hemopericardium, one of which was due to erosion of the left atrial roof while none of our patients had residual shunts. Two patients had anesthesia related complications, one patient developed nickel allergy and one patient had vascular complication. Conclusion: Although transcatheter ASD closure is a safe and effective procedure, but a wide range of complications should be anticipated and managed properly. In high volume centers with proper patient selection, complications could be significantly reduced but not completely abolished.

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Keywords

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