Cribriform Amplatzer Device Closure of Fenestrated Atrial Septal Defects: Feasibility and Technical Aspects (original) (raw)

2008, Pediatric Cardiology

Fenestrated atrial septal defects (F-ASDs) may pose a challenge to device closure; recently, a cribriform device with a minimal connecting intrawaist diameter and large, equal left-and right-sided discs has been designed to cover more than one adjacent defect. This study demonstrates the feasibility and technical aspects of closing F-ASDs using this new device. Sixteen patients between August 2003 and January 2006 were included in this study. The inclusion criterion was the presence of a F-ASD diagnosed by transesophageal echocardiography. One of the three available cribriform ASD device sizes (18, 25, or 35 mm) was implanted. Patients were followed for at least 1 year after the procedure. Thirteen patients had successful cribriform ASD device implantation (median age and weight, 12.5 years and 36 kg, respectively). Ten patients (62%) had an associated atrial septal aneurysm. The mean procedure time was 75.6 : 28.5 min and the mean fluoroscopy time 14.8 : 6.3 min. The RVEDD was significantly reduced, from a mean of 24.2 mm to 21.0 (p \ 0.05). One patient developed atrial tachycardia requiring cardioversion during the procedure. There were no embolic events, heart block, or mortality. Complete closure was 10 of 13 (77 %) the next day and 12 of 13 (92%) at 6 and 12 months. We conclude that the cribriform Amplatzer device can be successfully and safely used in patients with F-ASDs. Complete closure may take up to 6 months. Keywords Fenestrated atrial septic defect Á Multiple atrial septal defect Á Multiple ASD Á Amplatzer septal occluder Á Cribriform ASD device closure Atrial septal defect (ASD) accounts for 5%-10% of congenital heart malformations. Transcatheter closure of secundum ASD has become an alternative to surgery and the results have been mostly satisfactory. Several devices have been developed for this purpose, including the double umbrella device, buttoned device, CardioSEAL, Helex, and Amplatzer septal occluder [4, 10, 19, 24, 26-28, 32]. Large-diameter defects, multiple defects, and interatrial aneurysm with fenestrations may pose a problem to device closure [2, 21, 22, 24]. Percutaneous placement of multiple devices [23-26] or a single device after performing a balloon atrial septostomy may be required [7]. AGA Medical Corp. has recently developed the cribriform Amplatzer device, which is designed with a minimal connecting intrawaist diameter and large equal left and right discs to cover more than one adjacent defect. This study, in a cohort of patients with fenestrated ASDs (F-ASDs), reports and defines our initial experience. Methods Between August 2003 and January 2006, between two medical centers (Hamad Medical Center in Qatar and Cairo University in Egypt), 16 patients were diagnosed with