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- Publisher
- Wiley
- Copyright
- Copyright © 1998 Wiley Subscription Services, Inc., A Wiley Company
- ISSN
- 0896-4327
- eISSN
- 1540-8183
- DOI
- 10.1111/j.1540-8183.1998.tb00151.x
- Publisher site
- See Article on Publisher Site
Abstract
The atrial septal defect occlusion system (ASDOS) is one of the recently developed systems for nonsurgical closure of interatrial communications. The ASDOS occluder consists of two self‐opening umbrellas made of nitinol wire frame and polyurethane membrane. The unique ASDOS technique provides: (1) an “over‐the‐wire” individual umbrella manipulation within the atria; (2) several positioning and repositioning attempts; (3) simultaneous selective left atriography; (4) adjustable joining together of both umbrellas depending on the atrial septal wall thickness; (5) septal tissue immobilization in patients with septal aneurysm; and (6) controlled “over‐the‐wire” retrieval through the same 11Fr introducing venous sheath. The experimental studies showed a complete device incorporation after 3 months. The clinical experience accumulated during a 4‐year period confirmed the safety and efficacy of this system. The complete defect closure was achieved in two thirds of patients immediately after the procedure. A significant residual shunt remained in a small number of treated patients. Complications included: (1) thrombus formation around the device in some patients; (2) perforation of the atrial wall in patients with inappropriately implanted devices; and (3) an infectious endocarditis. Device frame fracture was observed in 14% of patients during a follow‐up of 250 patient‐years. There have been no late device dislodgment and no injury to the atrioventricular valves after ASDOS closure. The ratio of the diameter of the implanted umbrellas to the short atrial septal diameter ranged between 1.4‐2.2. Since it can immobilize the septum, the ASDOS proved to be especially indicated for closure of defects with aneurysm of the residual septum. In patients with a patent foramen ovale (PFO), the adjustable ASDOS umbrellas keep the valve of the oval fossa tightly closed to the secundum septum. Our experience confirms the feasibility of catheter techniques for treatment of patients with centrally situated secundum ASD or PFO.
Journal
Journal of Interventional Cardiology – Wiley
Published: Oct 1, 1998