Long term results of transcatheter non secundum atrial septal defect occlusion by the transcatheter patch. Lessons learned for future advances.

Background:
Non secundun atrial septal defects (ASDs), including sinus venosus (SV) and ostium primum (OP) ASDs are usually repaired by surgery. High risk for surgery, symptomatic adult patients could be conceivably helped by transcatheter methods providing acute and long term results are satisfactory.

Methods:
Five symptomatic adult patients with non secundum ASDs were referred for transcatheter patch(TP) repair (7-14yrs ago). They included two SV ASDs with normal pulmonary veins, one SV ASD with partial anomalous pulmonary veins and two OP ASDs without significant mitral insufficiency. Test balloon occlusion was performed prior to the actual transcatheter patch occlusion. Transesophageal echocardiography, fluoroscopy and cineangiography were used. Qp:Qs estimation before and after test balloon occlusion was also performed to assess the contribution of partial anomalous pulmonary venous return.

Results:
All cases had effective occlusion of their defect (full occlusion or small residual shunt). All had significant symptomatic improvement. The contribution of anomalous veins was negligible in the case of partial anomalous venous return. There was no new mitral insufficiency in the OP cases.

Conclusions:
The acute and long term results of non secundum ASD repair by the TP were good. The symptomatic relief was universal and lasting despite the occasional imperfect anatomic result. Further advances and clinical trials in selective cases of non secundum ASDs, are justified.