IMMEDIATE OUTCOME AFTER PERCUTANEOUS DEVICE CLOSURE OF SECUNDUM ATRIAL SEPTAL DEFECT

Abstract

Objective: To determine immediate outcome after percutaneous device closure of secundum atrial septal defect in children and adults.

Methodology: This descriptive study was conducted at Paediatric Cardiology department, Ch. Pervaiz Elahi Institute of Cardiology, Multan from 2011 to 2019. Patients with moderate to large ASD secundum with RV volume overload were selected .Patients below 10 Kg and with severe pulmonary hypertension were excluded. Procedures were performed either under general anaesthesia or deep sedation. Immediate outcome after procedure was studied.

Results: A total of 86 patients underwent ASD device closure. Mean age was 25 ± 1.4 (4 -54 years) and male to female ratio 1:2. Mean defect was 20.57 ± 0.57 (09 to 32 mm). Pulmonary valvuloplasty was performed in 03 patients (3.5 %). Device size was selected on the basis of echo measurement + 2-5 mm. Balloon sizing was performed only in 4 (4.6 %) cases. Septal occluders from different companies were used with equal good results.  Balloon assisted technique was used in 09 (10 %) patients. Two devices (2.3 %) were embolized. In both cases IVC margin was deficient .Transient arrhythmias were observed in 07 (8%). One patient each of pericardial effusion and clot on left atrial disc were observed and treated conservatively. There was no mortality.

Conclusion: Percutaneous closure of moderate to large ASD secundum in children and adults is a safe procedure with good immediate outcome. IVC margin is crucial to prevent device embolization. The most of the complications are uncommon, transient and can be managed.

Keywords: ASD secundum, Device Closure, immediate outcome