Atrial Septal Defect Ostium Secundum: A Comparative Study Between Surgical and Transcatheter Management Hammood Naser Mohsin* FIBMS, Jassim Mohammed Mahdy** FIBMS, Talat Rifat Rahman*** FIBMS

Keywords: Atrial septal defect, Surgical correction, Transcatheter Management, Transesophageal echocardiography, Fluoroscopy


Background: Atrial septal defect is one of the more commonly recognized congenital cardiac anomalies presenting in adulthood. Atrial septal defect is characterized by a defect in the interatrial septum allowing pulmonary venous return from the left atrium to pass directly to the right atrium .Atrial septal defects can be closed either by surgical or transcatheter closure.
Objectives: To provide a comparison between the surgical and transcatheter closure of atrial septal defects and study accuracy of transesophageal echocardiography in demonstrating atrial septal defect size and morphology.
Methods: Sixty patients their age ranged from one years to 46 years, median age was 25.33 years, 30 patients underwent surgical repair of atrial septal defects and 30 patients underwent transcatheter closure of atrial septal defects. Their data were collected and retrospective studied from 1/6/2013 to 1/6/2014 at Ibn- Alnafees teaching hospital for cardiothoracic surgery in Baghdad, Iraq. A comparison create between two groups according to age, sex, pre closure pulmonary hypertension, size of atrial septal defects, present of multiple atrial septal defects, procedure time, hospital stay time and post closure morbidity and mortality. Transesophageal echocardiograph findings were evaluated in relation of operative observations.
Results: There was no death in two groups, mortality was 0% in both groups. Residual shunt was not observed in any group. Failure rate of closure was much higher in transcatheter group than surgical group, 13.33% versus 0%. Cardiac tamponade was seen in one patient in transcatheter group 3.33% versus 0% in surgical group.
Conclusions: Surgical closure is the standard option for management of atrial septal defects. Transcatheter closure is limited to isolated atrial septal defects secundum with size less than 20 mm and a rim of 5 mm and over, there is no role of transcatheter closure in ostium primum and sinus venosus defects.