Transcatheter atrial septal defect closure: Modified balloon sizing technique to avoid overstretching the defect and oversizing the amplatzer septal occluder

Karina M. Carlson, Henri Justino, Richard E. O'Brien, V. Vivian Dimas, Glenn T. Leonard, Ricardo H. Pignatelli, Charles E. Mullins, E. O Brian Smith, Ronald G. Grifka

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

The objective of this study was to evaluate a new technique of sizing atrial septal defects (ASDs) for transcatheter device closure. ASD closure using the Amplatzer septal occluder (ASO) device is commonly performed. Complications, including arrhythmias, pericardial effusions, and perforations, may be related to oversizing ASDs and choosing larger devices. Two methods were used to size ASDs using a compliant balloon. In some patients, the balloon was inflated until a waist was visible [(+)waist]; in others, only until no shunting was demonstrable by echocardiogram [echo; (-)waist]. The device was selected and implanted using standard procedure and echo guidance. One hundred seventeen patients underwent secundum ASD closure with an ASO device. There were 43 patients in the (-)waist group and 74 in the (+)waist group. All devices were implanted successfully. The initial echo ASD diameter was larger in the (-)waist group compared to the (+)waist group (P = 0.01). There was a smaller difference between the initial echo and balloon-sized ASD diameters in the (-)waist group (P < 0.02). ASO device size implanted (in mm greater than echo ASD diameter) was smaller in the (-)waist group (P < 0.01). There were 0/43 complications in the (-)waist group and 5/74 in the (+)waist group. The complete closure rate was the same in both groups. Sizing an ASD by inflating a compliant balloon just until shunting is eliminated, and not until a waist is visible, results in less overstretching of the ASD and selection of a smaller ASO device, achieving similar closure rates and potentially fewer complications.

Original languageEnglish (US)
Pages (from-to)390-396
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume66
Issue number3
DOIs
StatePublished - Nov 2005

Fingerprint

Septal Occluder Device
Atrial Heart Septal Defects
Equipment and Supplies
Pericardial Effusion
Cardiac Arrhythmias

Keywords

  • Atrial septal defect
  • Balloon sizing
  • Interventional catheterization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Transcatheter atrial septal defect closure : Modified balloon sizing technique to avoid overstretching the defect and oversizing the amplatzer septal occluder. / Carlson, Karina M.; Justino, Henri; O'Brien, Richard E.; Dimas, V. Vivian; Leonard, Glenn T.; Pignatelli, Ricardo H.; Mullins, Charles E.; Smith, E. O Brian; Grifka, Ronald G.

In: Catheterization and Cardiovascular Interventions, Vol. 66, No. 3, 11.2005, p. 390-396.

Research output: Contribution to journalArticle

Carlson, Karina M. ; Justino, Henri ; O'Brien, Richard E. ; Dimas, V. Vivian ; Leonard, Glenn T. ; Pignatelli, Ricardo H. ; Mullins, Charles E. ; Smith, E. O Brian ; Grifka, Ronald G. / Transcatheter atrial septal defect closure : Modified balloon sizing technique to avoid overstretching the defect and oversizing the amplatzer septal occluder. In: Catheterization and Cardiovascular Interventions. 2005 ; Vol. 66, No. 3. pp. 390-396.
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AU - Leonard, Glenn T.

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