Should transcatheter closure of atrial septal defects with inferior-posterior deficient rim still be attempted?

P. Amedro (1, 2) , S. Bayburt (3) , A. Assaidi (4) , B. Kreitmann (5) , G. Kreitmann (4) , Virginie Fouilloux (4) , Alain Fraisse (6)

1 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
2 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
3 Acibadem University
4 TIMONE - Hôpital de la Timone [CHU - APHM]
5 UB - Université de Bordeaux
6 Royal Brompton and Harefield Hospital Trust,

Background: Transcatheter closure for atrial septal defect (ASD) with inferior-posterior rim deficiency hasbeen scarcely reported with proper identification of the indications and limits. We aimed to assess the safetyand feasibility of transcatheter closure of ASDs with deficient rims, paying particular attention to cases withinferior-posterior rim deficiency.Methods: From January 2008 to January 2013, 241 patients underwent transcatheter ASD closure,including 50 cases (20.7%) with deficient rims, other than the anterior-superior one. Eighteen patients(12 females) presented inferior-posterior rim deficiency. Their median age was 8 (1.4–85) years and theirmedian weight was 24 [9–97] kg. Transcatheter closure was performed in all cases under transesophageal echocardiography (TEE) guidance in children and intracardiac echocardiography (ICE) guidance in adults.Results: Out of 18 patients with inferior-posterior rim deficiency, only 8 underwent successful immediate transcatheter closure. Four cases failed to be closed. Major complications occurred in 6 patients, including 4 device embolizations, 1 pericardial effusion and 1 complete atrioventricular block that resolved after surgical removal of the device. During a median follow up of 54±13 months, a residual right-to-left shuntwas documented in 2 more cases, requiring surgery in one case because of cyanosis. Transcatheter closure was successfully performed in the rest of the 223 patients, including in the 32 cases with deficient rims other than inferior-posterior.Conclusions: Transcatheter closure of ASDs with inferior-posterior rim deficiency cannot be

Domaines: Sciences du Vivant [q-bio]

P. Amedro, S. Bayburt, A. Assaidi, B. Kreitmann, G. Kreitmann, et al.. Should transcatheter closure of atrial septal defects with inferior-posterior deficient rim still be attempted?. Journal of Thoracic Disease, In press, ⟨10.21037/jtd.2019.02.89⟩. ⟨hal-02073730⟩