The Clinical Research Of Transcatheter Atrial Septal Defect Occlusion With Amplatzer Septal Occluder In Children

Objective:To investigate the indication, methodology and complication of transcatheter closure of secundum atrial septal defect (ASD) with Amplatzer septal occluder (ASO).Materials and methods:A retrospective analysis was performed on 141 patients with ASD from October 2001 to October 2005. Transcatheter closure for secondum ASD was performed under basal anesthesia and sacral anesthesia. 141 patients were treated for ASD with transcatheter closure, of whom, 7 patients were multiple ASD, 9 patients were associated with pulmonary stenosis ( PS ), 2 patients associated with patent ductus arteriesus ( PDA ) , and 2 patients were remained ASD post opearation because of complex congential heart disease. The age of the cases ranged from 1 to 17 ( 5.78±3.70 ) years and the body weight ranged from 7.5 to 59 (19.51±9.57 ) kg. They all met the criteria for transcatheter closure. The balloon stretched diameter of ASD was determined with fluoroscopy and ultrasound. A choice of device size was identical to or 1-2 mm larger than the stretched diameter (SD). A simultaneous PDA closure with device or balloon dilation was done in 11 cases associated with PDA or PS, respectively. Follow-up was performed based on the echocardiographic and clinical findings. Results:In 141 cases examined with trans-thoracic echocardiography (TTE), ASD mean diameter was 13.40±6.20 (5-35) mm, and SD was 17.10±7.50 (5-36) mm. The diameters of these devices were 18.14±7.14 (6-38) mm. The devices were successfully implanted in 136 cases, of them, 6 patients had multiple ASD with one device occlusion. 11 cases associated with PDA or PS were treated successfully with PDA occlusion or ballon dilatation, respectively. The total follow up period was from 1 to 5 years. Residual shunt remained in 1 case. Infective endocarditis was found in 1 case after 4 months following surgery. Headache was found in 1 case and supraventricular tachycardia was found in 1 case.Conclusion:1. Transcatheter closure of secundum ASD using the ASO is a safe and effectivemethod.2. Hybrid procedure, combining surgical and interventional catheterization procedures, have been introduced to treat some complex congenital heart diseases.3. Not all tyes of ASD can be closed by transcatheter closure.