Title:First Comprehensive Analysis of Outcomes in Adult Patients after Percutaneous Closure of Isolated Secundum Atrial Septal Defects
VOLUME: 13 ISSUE: 1
Author(s):Armita Atashband and Nasser Lakkis
Affiliation:Baylor College of Medicine, Ben Taub General Hospital, Section of Cardiology, 1504 Taub Loop, Houston, TX 77030, USA.
Keywords:Arrhythmias, atrial septal defect, congenial heart defect, percutaneous closure, pulmonary hypertension,
transcatheter closure.
Abstract:Background: Secundum atrial septal defect (ASD) is a common congenital heart defect in
adults. If untreated, ASD leads to right ventricular (RV) failure, atrial arrhythmias, and pulmonary
hypertension. The aim of this study is to analyze published data on outcomes and complications of
percutaneous ASD closure in adults.
Methods: PubMed searches performed for published literature on percutaneous ASD closure using the
terms ASD, ASD closure or repair, and percutaneous or transcatheter closure.
Results: A total of 23 studies, 1958 patients, were analyzed. Baseline characteristics showed mean age of 49.1 ± 1.7 years,
Qp:Qs of 2.2 ± 0.05, defect size 19.4 ± 1 and device size 24.0 ± 0.7. The percentage of patients in NYHA class I, II and III
was 42.4 ± 6.3, 40.0 ± 6.5, and 9.3 ± 3.0, respectively. Mean follow-up was 12.6 ± 4.9 months with a closure rate of
96.9% ± 1.4. Echocardiographic parameters of improvement included decrease in RV volume from 157.2 to 100.2 mL (p
= 0.02), RV end-diastolic dimensions from 40.8 to 32.4 mm (p < 0.0001) and pulmonary artery systolic pressures from
42.2±2.2 to 34.4±2.4 (p < 0.0001). The percentage of patients in NYHA class II and III decreased from 55±7.5 to
15.9±4.4 (p = 0.0013). At the end of follow-up, complications included 1% mortality rate, 0.8% device embolization,
5.8% new onset arrhythmias and 1.2% need for surgical closure.
Conclusion: Our study confirms that percutaneous ASD closure in adults with moderate pulmonary hypertension and RV
dilation is safe and effective with reverse remodeling and better functional capacity. Prospective studies are needed to evaluate
efficacy of percutaneous ASD closure in adults with large defects, higher shunt ratios, and severe pulmonary hypertension.
