Background: Transcatheter occlusion of uncomplicated atrial septum defects (ASD) is recognized
as an effective and minimally invasive method. Sometimes, serious early and late complications
require surgical intervention. We therefore investigated reasons and outcomes of the
secondary surgical approach. Methods: 5 patients (aged 5 - 73 yrs) were admitted to our institution for device explantation
and surgical ASD closure. ASDOS devices (A devices) had to be explanted in 4 patients
and a SIDERIS “buttoned” occluder (S device) had to be explanted in 1 patient. The
period from transcatheter implantation to surgical explantation ranged from 1 hour
to 3 years. Results: 3 patients (60 %) had to be operated in an emergency setting. In our youngest patient
(5 yrs), the A device separated and embolized into the aorta and pulmonary artery.
A pregnant women who needed emergent cesarean section developed hemopericard and tamponade
due to atrial perforation by a fractured leg of an A device. In another A device,
a suspect endocarditis caused membrane perforation. Malpositioning of an S device
was the reason for operation. All patients recovered well without neurological symptoms.
Conclusions: Transcatheter closure of uncomplicated ASD is a feasible alternative but surgical
stand-by is essential. Nevertheless more complicated ASD should be operated, especially
since the cosmetically satisfactory techniques of minimal invasive heart surgery are
available.
Key words:
Complications - Transcatheter ASD closure - Surgical repair
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1 This paper was presented at the 30. Annual Meeting of the German Society for Thoracic
and Cardiovascular Surgery, Leipzig, Germany, February 18 - 21, 2001
Fritz Mellert,MD
Department of Cardiac Surgery
Friedrich Wilhelms University
Sigmund-Freud-Straße 25
53105 Bonn
Germany
Phone: +49 (228) 287-4190
Fax: +49 (228) 287-4195
Email: fritz.mellert@uni-bonn.de
