At Marie Lannelongue Hospital between 1998 and 2013, 1470 consecutive patients attempted Atrial Septal Defect (ASD) closure with the Amplatzer Septal Occluder (ASO), including 336 patients (161 children <15 years old) with very large, isolated, secundum ASD. Very large ASD was defined as a balloon stretched-diameter ≥34mm in adults or an echocardiographic diameter>15mm/m² in children. Procedure was performed under TTE guidance in 219 patients (65.2%, all patients since 2005). The balloon stretched-diameter was greater than 40mm in 36 patients. In the rest of the cohort, it was measured at 37.6 ± 3.3mm in adults and 26.3 ± 6.3 mm/m² in children. Percutaneous ASD closure was successful in 311 patients (92.6%, 95%CL:89-95). Both deficient superior and posterior rims were more frequent in failing procedures compared to successful ones, respectively 24.0% versus 4.8% (p<0.001) and 32.0% versus 4.2% (p<0.001). ASO migration occurred in 4 (1.2%) adults [2 surgical and 2 transcatheter device retrieval] whereas ASO was unreleased and withdrawn in the 21 (6.2%) other failing cases. After a mean follow-up of 6.7±3.2 years, all patients are alive and no late complication occurred.
Conclusions: Transcatheter closure of very large ASD with the ASO is safe and effective in both adults and children. Deficient superior and posterior rims are associated with procedural failure. Closure can be performed under TTE guidance in experienced centers. Early ASO migration is rare and suitable for device extraction without life-threatening complication. Long-term follow-up is free from death or late adverse event.
