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Title: Transcatheter occlusion of complex atrial septal defects
Authors: De Lezo, José Suárez
Medina, Alfonso
Pan, Manuel
Romero, Miguel
Segura, José
Pavlovic, Djordje
Hernández, Enrique
Delgado, Antonio
Caballero, Eduardo 
Siles, Juan Ramón
Franco, Manuel
Mesa, Dolores
Lafuente, Mercedes
UNESCO Clasification: 32 Ciencias médicas
3213 Cirugía
Keywords: Double-Umbrella Device
Buttoned Device
Echocardiographic Predictors
Catheter Closure, et al
Issue Date: 2000
Journal: Catheterization and Cardiovascular Interventions 
Abstract: Percutaneous device occlusion of secundum atrial septal defects (ASDs) is becoming an accepted alternative to surgical closure. This method allows us to evaluate patients with complex conditions for treatment. From a total of 70 patients with ASD evaluated for percutaneous closure, we selected for analysis 28 who had complex conditions. The mean age was 36 +/- 23 yr (range, 4-72). Six had heart failure, and of these six, three had atrial fibrillation. At cardiac catheterization, the pulmonary pressure was 47 +/- 24 mm Hg, and the QP/QS was 1.7 +/- 0.4; two patients had bidirectional shunt and systemic pulmonary pressure. Two patients received a buttoned device and 26 an Amplatzer septal occluder, The groups of patients with complex conditions were separated into the following groups. Group I (n = 4) underwent combined treatment of associated anomalies. Two patients had pulmonary stenosis, one had mitral stenosis, and one had an aortic root-left atrium fistula. They were treated in or during with the same procedure by combined transcatheter techniques (balloon valvuloplasty and fistula occlusion) before ASD occlusion. Group II (n = 9) had multiple defects (cribiform or two separate holes). They were treated with a single device in five instances and with two separate devices in four cases. Group III (n = 14) had large (32 +/- 3 mm) single defects, Nine of them underwent successful implantation using a device 33 +/- 3 mm in diameter; in the remaining five patients the device was removed because of instability. Group IV (n = 3) had residual defects after previous partial device occlusion. All three defects were successfully occluded with a second device. No movement or interference with the first device was observed. Group V (n = 6) had severe pulmonary hypertension (86 +/- 16 mm Hg). Immediately after ASD occlusion we observed significant relief in these patients (67 +/- 14 mm Hg; P < 0.01). There were no major complications; all 23 patients with successful implants were discharged without symptoms 2-7 days later; one patient with atrial fibrillation recovered sinus rhythm. The follow-up (8 +/- 5 mo) Doppler echo study showed complete ASD occlusion in 22 patients and 8 peak pulmonary pressure of 30 +/- 14 mm Hg, We conclude that transcatheter occlusion of ASDs is an effective and safe treatment for patients with complex anatomic or physiopathologic conditions, as evaluated by shortterm follow-up.
ISSN: 1522-1946
DOI: 10.1002/1522-726X(200009)51:1<33::AID-CCD9>3.0.CO;2-5
Source: Catheterization and Cardiovascular Interventions[ISSN 1522-1946],v. 51, p. 33-41
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