Circulation, Vol 88, 621-627, Copyright © 1993 by American Heart Association
C Boutin, NN Musewe, JF Smallhorn, JD Dyck, T Kobayashi and LN Benson
BACKGROUND. Transcatheter device occlusion of atrial septal defects is an
attractive approach, but its efficacy and place in patient management
remain to be determined. METHODS AND RESULTS. To evaluate the medium-term
results of atrial septal defect device occlusion and factors influencing
residual shunting, transesophageal and transthoracic echocardiograms of 49
patients were reviewed. Transesophageal echocardiograms on 48 patients
immediately following surgical closure revealed residual shunting in 2%
compared with 91% after device occlusion; this proportion decreased to 53%
after a mean follow-up of 10 months. The actuarial analysis suggests a
progressive resolution of shunting with time. One patient had residual
shunting by transesophageal echocardiography immediately after surgical
closure compared with 29 after a mean follow-up of 10 months after device
occlusion. Residual shunting was not influenced by (1) dimension, location,
or position with relation to the device as assessed by transesophageal
echocardiography; (2) location of the defect; or (3) device size relative
to the stretched dimension of the defect. In 15 patients, a poor
correlation existed between transesophageal and transthoracic
echocardiographic findings. Variability in serial transthoracic
echocardiographic findings was observed in 14. Right ventricular dimension,
heart size, and presence of a murmur at follow- up did not correlate with
the presence or size of residual shunting after device occlusion.
CONCLUSIONS. These results suggest that ongoing spontaneous resolution of
residual shunting occurs after device insertion. Factors related to the
defect or device could not predict eventual resolution of residual
shunting. Transthoracic echocardiography in the follow-up of these patients
may not be reliable in determining presence of residual shunting.
ARTICLES
Echocardiographic follow-up of atrial septal defect after catheter closure by double-umbrella device
University of Toronto, Department of Pediatrics, Ontario, Canada.
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