| Background.There are few reports on peratrial device occlusion of large secundum atrial septa]defect in adults and long term follow-up after occlusion of such large secundum atrial defects.There is very little work on peratrial device occlusion of atrial septal defects and a great deal of work is required to introduce this technique to the whole world.Objectives.This study aims to provide effective results of occlusion of large secundum atrial septal defects and demonstrate that these large atrial septal defects can be occluded by peratrial technique.The presence of recommended length of rims of less than required length of one of rims is also made a debate point for outcomes of occlusion.This study aims to provide evidence of safety,efficacy,feasibility and simplicity of peratrial device occlusion of large secundum atrial septal defects in adults only without any other carrdiac disease.Method.In this study 90 patients with maximum diameter of more than 30 millimeterof secundum atrial septal defect underwent peratrial device occlusion under transesophageal echocardiographic guidance in our institute.The patient was placed in supine position.Under general anesthesia a 2 to 3cm incision was made in right 4th parasternal intercostal space.The lung was protected by placing a wet gauze between lung and pericardium.The pericardium was incised at laterally projecting part and was suspended using 4 sutures.The suspension sutures were placed superiorly and inferiorly each on opposite side of incised pericardium.Then the suspension of pericardium was achieved by four mosquito artery forceps one for each suture.The projection part of the right atrium was visually identified and two purse-string sutures were placed with a Rummel tourniquet for each.A puncture was made within purse-string sutures and a specially designed short delivery sheath loaded with device was advanced through the purse-string sutures into right atrium.The delivery sheath then was advanced to left atrium under transesophageal guidance.The left disk of the device was expanded in left atrium,delivery sheath was then pulled to right atrium and left disk of the device was anchored to left of atrium septum deployed under transesophageal echocardiographic guidance.Then the right disk of the device was expanded by keeping the pull on delivery sheath and retracting the delivery sheath.A standard push and pull maneuver was done to check the stability of the occlusion device.Once satisfactory results were seen the device was released.The whole procedure was done under transesophageal echocardiography and no fluoroscopy was used.Results.The procedure was successful in all patients.The age of all the patients ranged from 18 to 70 years(mean age 40.6 ± 13.6).The body weight of all patients ranged from 43 to 87 KG(mean KG 61 ± 10).The maximum diameter of ASD for all patients ranged from 30 to 43 mm(mean diameter 32 ? 2.4).The one of rims was short(?5mm)in 19/90 patient and was sufficient in remaining 71/90 patients.The mean size of implanted devices was 36 ± 2.7 for all patients.The replacement of the device was done in 17/90 patients.The device was replaced with a smaller device in 7/17 patients.And it was replaced with a larger size in 10/17 patients.The total intracardiac manipulation time for all the patients was 8.1±7.9 minutes.The total procedural time was 57± 14 minutes in all patients.The total occlusion rate was 91%immediately after occlusion,97%at 6 months,98%at 1 year,and 100%at ?2 years follow-up.There were no early or late complications during the follow up period of 6 to 72 months(mean 54 ± 36 months).Conclusions.Peratrial device occlusion of large secundum atrial septal defect in adults is safe,effective,feasible and simplest of atrial septal defects' procedure.The long term results are very promising.The short rim and consequent selection of larger device had no negative effects on outcomes. |
PDF Full Text Request