Background: We reviewed our experience using the Amplatzer septal occluder (AGA Medical, Golden Valley, MN) to close large, secundum-type atrial septal defects (ASDs) in children. Methods: Between June 2002 and December 2005, 52 patients (mean age 13.5 ¡Ó 8.7 years) underwent transcatheter closure of large (≥25 mm), secundum ASDs by using the Amplatzer septal occluder (ASO). Groups 1 and 2 included patients with a retroaortic rim of <5 mm (n = 39) or ≥5 mm(n = 13), respectively. All procedures were performed with general anesthesia and transesophageal echocardiographic guidance except for 10 patients, which involved local anesthesia and 3-dimensional transthoracic echocardiography. Successful device implantations, device sizes, approaches, complications, and closure rates were assessed. Results: Device implantation was successful in 50 patients (96.1%), with no difference between groups (95% vs 100%, P > 0.05). In 2 patients, implantation failed because of embolism or deployment failure. Devices were larger in group 1 than in group 2 (29.7 ¡Ó 3.9 vs 26.7 ¡Ó 3.0 mm, P =0.04). The right upper pulmonary-vein approach was more common in group 1 than in group 2 (P = .0001). Complications and closure rates did not differ between the groups (P > .05). Conclusions: Transcatheter closure of large, secundum ASD by using the ASO device was feasible, and complication rates were low. A deficient retroaortic rim did not preclude successful device implantation; however, a large device may be needed to close large ASD. Close long-term follow-up is necessary to determine the safety of transcatheter closure of large ASDs in children.

Abstract: Background: At present, device closure of interatrial communication has become a well established technique in order to adequately treat severe left-to-right shunt associated with ASDs. During the traditional procedure, fluoroscopy with the waist of a compliant balloon is used to determine the appropriate size of the closure device and defect sizing. Choice of adequate closure device using transthoracic echocardiography (TTE) has been hitherto unreported. Methods & Materials: Between December 2002 and October 2004, 40 patients (15 males, 25 females, mean age; 11.7 ¡Ó 7.8 years ) with secundum ASDs underwent transcatheter closure at our institution. In group 1, 30 patients had the procedure by balloon sizing and TTE sizing. In 10 patients (group 2), TTE sizing was used as the sole too l for selecting device size and the device size was chosen to be based on the Amplatzer septal occluder ( ASO ) size and TTE size ratio in group 1. The procedure was performed under continuous transoesophageal echocardiographic monitor with general anesthesia. Results: The correlation was found between TTE and stretched balloon sizing diameter SBD ( y= 1.2645x-1.4465; R&#x00B2;=0.9861 ), and between TTE size and ASO size ( y = 1.3412x-1.2864; R&#x00B2;=0.9929 ) in group 1. In group 2, statistical correlation between TTE and ASO ( y=1.3419x-0.1172; R&#x00B2;=0.9934 ) was also found. Good linear regression between TTE size and ASO chosen size was noted in group 1 and group 2 (R&#x00B2;=0.99).In group 2, successful device implantation was accomplished in all patients whose device size was chosen to be based on the ASO and TTE ratio in group 1. Conclusions: TTE sizing is a safe and ideal method to measure interatrial defect and choose the occluding device respectively. With our experience, the sizing based on the TTE is generally easier than measurement from the balloon sizing.