[Percutaneous closure of large atrial septal defects].

BACKGROUND Percutaneous occlusion of secundum type atrial septal defect with an Amplatzer device is an effective treatment alternative. However, there is little information about the use of this treatment for large defects. PATIENTS AND METHOD We retrospectively analyzed the initial and follow-up findings in 31 patients aged 41 18 years who had large atrial septal defects (>= 30 mm diameter). Mean defect diameter evaluated by the balloon occlusion method was 33.4 3.4 mm (range, 30-40 mm). In all patients we attempted the implantation of an Amplatzer septal occluder. RESULTS The implant was successful in 23 patients (74%); 3 of whom had a double orifice. The size of the device was 34 3 mm diameter (range, 30-38 mm). Combined associated procedures were balloon pulmonary valvuloplasty in 3 patients and coronary stent implantation in 1. In 4 out of 8 patients where we failed, the implant was attempted but the device was unstable so we decided to retrieve it; in the remaining 4 patients, balloon measurement alone contraindicated the procedure. All patients did well, but one had cardiac tamponade during the procedure that was resolved in the catheterization laboratory. After 15 12 months of follow-up all 31 patients were alive and those who had functional limitation before treatment remained stable, with significant clinical improvement. CONCLUSIONS Percutaneous device occlusion of large atrial septal defects is feasible and effective in most patients.