DEVICE CLOSURE OF ASD- LONG-TERM FOLLOW UP WITH SPECIAL REFERENCE TO COMPLICATIONS


Masood Sadiq, M.D., The Childrens Hospital, Punjab Institute of Cardiology, Lahore, Pakistan

Device closure of ASD is now standard of treatment for suitable defects. There are however concerns over long-term outcome of device closure with special reference to complications mainly erosions and aortic regurgitation. The long term data is now available. Kutty et al reported the results of a retrospective observational outcomes study (AJC 2012), comparing long-term results of transcatheter and surgical ASD closure. This study represents the longest reported duration of follow-up after transcatheter closure with a mean follow up of 10 years. All cause mortality rates following transcatheter ASD closure compare favorably to surgical closure. We have reported on 205 patients with secundum ASD (CTY 2012). Device closure was successful in 200/205 (98%) patients. Early complications included embolization (4 pts), pericardial effusion, 2:1 heart block and infective endocarditis (1patient each). Eight patients reported migraine (3.9%). At median follow up of 5.8(0.6-10.3) years, complete closure occurred in 197/200 patients. Two patients developed mild AR (1%). There were no erosions, late embolisation or thrombo-embolism. Atrial fibrillation occurred in 3 adults (1.5%). Between December 2001 and March 15, 2012, 97 worldwide cases of erosion have been identified in association with the on label use of the ASO device, representing an overall risk of erosion of 0.043%. Device closure of secundum atrial septal defects using Amplatzer septal occluder is safe and effective in long- term. The risk of developing aortic regurgitation is low. Erosions do occur but risk is extremely low and can be minimized further by taking precautions in case and device selection.