Peratrial device occlusion of large secundum atrial septal defect in adults: Long term follow-up results

Background: There are few reports on peratrial device occlusion of large secundum atrial septal defect in adults and long term follow-up post occlusion. Objectives: This study aims to provide evidence of safety, efficacy, feasibility and simplicity of peratrial device occlusion of large secundum atrial septal defects in adults. Method: Ninety patients with maximum diameter of ≥ 30mm of secundum atrial septal defects underwent peratrial device occlusion. A 2 to 3cm incision was made in right 4th parasternal intercostal space. The pericardium was suspended. A specially designed short delivery sheath loaded with device was advanced through the purse-string sutures placed on projecting part of right atrium. The device was deployed under transesophageal echocardiographic guidance. Results: The procedure was successful in all patients. The age ranged from 18-70 years (mean 40.6 ± 13.6). The body weight ranged from 43 - 87 KG (mean 61 ± 10). The maximum diameter of ASD ranged from 30 – 43 mm (mean 32 ± 2.4). The one of rims was short (≤5mm) in 19/90 patient and sufficient in remaining 71/90 patients. The mean size of implanted devices was 36 ± 2.7 for all patients. The device was replaced with a smaller and larger size in 7/17 and 10/17 patients respectively. The total intracardiac manipulation time was 8.1±7.9 minutes. The total procedural time was 57±14 minutes. The total occlusion rate was 91% immediately after occlusion, 97% at 6 months, 98% at 1 year, and 100% at ≥2 years follow-up. There were no early or late complications during the follow up period of 6-72 months (mean 54 ± 36months). Conclusions: Peratrial device occlusion of large secundum atrial septal defect is safe, effective, feasible and simplest of atrial septal defects’ procedure. The long term results are very promising. The short rim and consequent selection of larger device had no negative effects on outcomes.