INTRODUCTION: Transcatheter Atrial Septal Defect (ASD) closure is a worldwide accepted alternative to surgical repair. The use of more than one device has been described, however, there are just a limited number of studies available with a long term follow-up. In this study, the authors present their experience in transcatheter closure of multiple atrial septal defects utilizing more than one device, and discuss the different situations where this approach has become necessary. METHODS: This is a retrospective study where all patients submitted to ASD device closure from April 1999 to December 2007 were analyzed. We selected those with multiple ASD and focused our study on those who had two devices implanted. We also included two patients who had significant residual shunts after the first procedure and were closed with a second device. All patients were selected based on transesophageal echo-cardiogram (TEE) results. RESULTS: In the aforementioned period, 211 patients were submitted to transcatheter ASD closure. Twelve (5.6%) patients needed two devices to close their defects, described as follows: eight patients had 2 orifices, two had 3 orifices, and two had 4 orifices. Mean age was 27.5 ± 14.6 years. Two patients suffered ischemic cerebral events (stroke) prior to occlusion. Twenty-four devices were utilized: 23 Amplatzer ASD Occluder devices and one 25mm Amplatzer PFO Occluder device. The device implantation was possible in all cases. Average diameter for small defects was 10.5 ± 4.0 mm, and 20.6 ± 5.5 mm for larger defects. Mean central diameter of the devices varied from 5 to 34 mm (16.8 ± 7.6 mm). There were no major complications or deaths related to the procedure. Immediate post-procedural residual shunts were present in two (16.6%) patients. Two additional patients were included with significant residual shunt that required a second Amplatzer ASD device. CONCLUSION: Although technically more demanding, two device ASD closure is feasible, safe and effective. Implanting two metallic devices does not seem to be deleterious to atrial septum or surrounding structures, so far. In spite of that, more studies are deemed necessary to define the safety of the procedure, especially in children.
Heart septal defects, atrial; Heart catheterization; Prostheses and implants
