Introduction:
The Transcatherer Patch (TP) is a bioabsorbale device used in the occlusion of septal defects including atrial septal defects(ASDs) and ventricular septal defects(VSDs) the last 15 years. Acute results have been described as effective occlusions with rare small residual shunts and occasional instability of the immediately release patch on the septum.
Hypothesis:
Long term results of successful implantations were critically examined to determine effectiveness of occlusion and the extent of septal reconstruction.
Method:
The records of 200 successfully implanted devices (149 ASDs, 51 VSDs) were analyzed. ASDs were of secundum type with the exception of five that were ostium primum and sinus venosus types. All VSDs were peri-membranous except for four malalignment (Fallot Tetralogy) and one muscular defect. Defect size varied from 13 to 35mm for ASDs and 4-16mm for VSDs. The TP was deployed in three versions including, temporary double balloon support (48hrs), temporary double balloon support with surgical adhesive (45min - 2hrs), and extended single balloon support with immediate release.
Results:
Long term results were free from deaths or serious complications including perforation, erosion, heart block, thrombus, and arrhythmia. All occlusions were effective with occasional persistence of trivial residual shunts. The septum was normalized and the patch was undetectable by echocardiography 1-2yrs after implantation. Normalization of the septum required a longer period of time with the immediate release patch.
Conclusions:
Long term results of the TP in septal defect occlusion were excellent. Serious complications seen with metallic devices did not occur. The TP offers a promising alternative in septal defect occlusion although further improvements must be made to eliminate rare acute problems and residual shunts. A double balloon immediately released patch could be a solution.
B
Mitral balloon valvotomy, long-term results, its impact on severe pulmonary hypertension, severe tricuspid regurgitation, atrial fibrillation, left atrial size, left ventricular function
