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Long-Term Follow-Up of Transthoracic Echocardiography-Guided Transcatheter Closure of Large Atrial Septal Defects (≥ 30 mm) Using the SHSMA Occluder

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Abstract

Transcatheter closure of large atrial septal defects (ASDs) remains controversial. The aim of this study was to evaluate the feasibility and safety of transthoracic echocardiography (TTE)-guided transcatheter closure of large ASDs. Patients with large secundum ASDs (≥ 30 mm) who underwent device closure were retrospectively reviewed. TTE was performed to guide ASD occluder positioning and assess the immediate and long-term outcomes. A total of 60 patients (median age 43.5 years, range 15–78 years) were enrolled in the study. The median ASD size was 35 mm (range 30–42 mm). Mild to moderate pulmonary hypertension was observed in 36 patients (60%). Thirty-one patients (51.7%) had one short rim, and 18 patients (30.0%) had two deficient rims. Placement of the device was successful in 57 patients (95%), and the median device size was 42 mm (range 40–50 mm). Dislodgement of the device occurred in three patients with two deficient rims: a larger device was redeployed in one case, and two patients required surgical repair. During a median follow-up of 37 months (range 6–83 months), no residual shunts, erosion, or embolization were noted, and pulmonary hypertension resolved in 75% of the patients. Thus t vast majority (95%) of large ASDs can be successfully closed percutaneously using the Chinese-made Shanghai Shape Memory Alloy (SHSMA) occluder under TTE guidance. Long-term follow-up showed that transcatheter closure could become a safe and effective alternative to surgery in select large ASDs.

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Author notes

  1. Hongwei Dou, Tong Kan, and Xian Guo contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China

    Hongwei Dou, Tong Kan, Xian Guo, Pan Li, Xudong Xu, Yongwen Qin & Xianxian Zhao

  2. Department of Ultrasonography, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China

    Lingxiao Wang

  3. Department of Cardiology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, 164 Lanxi Rd, Shanghai, 200062, China

    Jian Na

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  1. Hongwei Dou
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  2. Tong Kan
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  3. Xian Guo
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  4. Lingxiao Wang
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  6. Pan Li
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Correspondence to Pan Li, Xudong Xu or Xianxian Zhao.

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Dou, H., Kan, T., Guo, X. et al. Long-Term Follow-Up of Transthoracic Echocardiography-Guided Transcatheter Closure of Large Atrial Septal Defects (≥ 30 mm) Using the SHSMA Occluder. Pediatr Cardiol 41, 716–723 (2020). https://doi.org/10.1007/s00246-020-02288-0

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