Transesophageal echocardiography to evaluate success of transcatheter closure of large secundum atrial septal defects in adults using the buttoned device

OBJECTIVES: To determine the success rate of transcatheter closure of secundum atrial septal defects (ASDs) in adults and to characterize anatomical structures predisposing to unsatisfactory results. PATIENTS AND METHODS: Preinterventional and follow-up transesophageal echocardiography of 17 consecutive patients treated with a Sideris buttoned device was reviewed. Residual jet size of 5 mm or smaller was considered an adequate result; jet size larger than 5 mm was inadequate. Maximal ASD diameter, ASD area, and anterior, posterior, superior, and inferior septal rims were measured. RESULTS: The 7 patients with adequate results (41%) had smaller defects before implantation of a buttoned device (mean +/- SD maximal ASD diameter, 12 +/- 4 vs 19 +/- 5 mm; P<.005). Total rim length (mean +/- SD) was longer in patients with an adequate result (71 +/- 8 vs 46 +/- 11 mm; P<.001). The ASD size and length of the superior septal rim were independent predictors for an adequate result. Only 3 patients, all with ASD diameter less than 13 mm, had completely closed defects. All patients with ASD diameter greater than 20 mm had inadequate results and an unsatisfactory device position. The defect size (mean +/- SD) was similarly reduced in patients with adequate and inadequate results (9 +/- 3 vs 8 +/- 4 mm). CONCLUSION: Adults with a small ASD are more likely to have an adequate result after treatment with the buttoned device. A sufficiently large superior septal rim is particularly important for an adequate result. Most patients with a large ASD have inadequate results, although their ASD size is reduced by a similar absolute area as in patients with an adequate result.