Intraoperative Device Closure Atrial Septal Defect in Adults : Immediate , Short , and Intermediate-Term Results

The intraoperative device closure of the atrial septal defect (ASD) has become an alternative technique to surgical procedures. The aim of this study was to assess the immediate, short, and intermediate-term results of the intraoperative device closure the secundum ASD in adult. Between September 2012 and November 2014, the intraoperative device closure the ASD was attempted in 21 consecutive, adult patients. The mean age of the patients was 17.25 ±20.41years (range =1-62 years). All the procedures were performed under general anesthesia with transthoracic or transesophageal echocardiography guidance. The diameter of the ASD was determined with echocardiography, and device selection was based on and matched to the diameter of the septal defect. Transthoracic echocardiography or transesophageal echocardiography was performed immediately after the release of the device and before discharge. Further follow-up at one month, six months, and yearly thereafter included physical examination, chest Xray, electrocardiography, and transthoracic echocardiography. The mean ASD diameter, as measured by echocardiography, was 11.4± 5.3 mm (range = 532 mm). Deployment of the occluder was successful in 21 (91 %) patients and failed in 2 (9%). Echocardiography at 24 hours, 1 month, 6 months, and 12 months after the procedure showed residual shunts in 0 (0%), 4(19%), 3(14%), and 2 (9%) patients, respectively. At the end of the follow-up, 2 (9%) patients had mild residual shunts: The shunt was small in the 2 (9%). The overall success rate of the intraoperative device closure of the ASD was 91% (19 of 21 cases). The intraoperative device closure of the secundum ASD in our adult patient population was associated with high degrees of success, minimal procedural complication rates, and excellent short and midterm results. Further experience and long-term follow-up are required before a widespread clinical use can be recommended.