Percutaneous Device Closure of Atrial Septal Defect: Neglected Long-Term Effects on the Left Atrium

摘要

Atrial septal defect (ASD) is a common congenital heart disease in adulthood that can be isolated or associated with other abnormalities. It is generally recommended to close this defect if it is associated with significant left-to-right shunt with right heart enlargement or paradoxical embolism. While surgical repair of ASD is a low-risk procedure, it can be associated with morbidity related to cardiopulmonary bypass, thoracostomy and atriotomy. Since the initial cases of successful transcatheter ASD closure were reported in the mid1970s,1)2) percutaneous device closure has become widely accepted as an alternative for surgical closure of small- or moderate-size secundum ASDs if the morphologic characteristics are appropriate. Several devices are currently available for transcatheter closure, and the factors that affect successful device closure to achieve optimal outcomes include the patient's comorbidities, preprocedural criteria for selection, and postprocedural care. Prior observational studies have shown that, compared to surgical closure, percutaneous closure has a similar efficacy rate with shorter hospital stays and lower rates of early complications.3)4) However, there have been concerns about potential long-term complications including arrhythmia, embolic events, residual shunt, erosion of cardiac structure by the device, and even sudden death.5-7) Long-term clinical outcomes following transcatheter ASD closure remain less certain.