Atrial septal defect percutaneous closure complications
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Atrial Septal Defect Microchapters | |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3] Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]
Overview
As with any invasive treatment, percutaneous closure could be associated with potential complications. Common complications include issues with device functional integrity such as embolization around the device or erosion of the materials and malpositioning. Other complications include potential for development of serious circulatory conditions such as atrial fibrillation, heart block, and thrombus formation.The disadvantages are a thick profile of the device and concerns related to a large amount of nitinol (a nickel-titanium compound) in the device and consequent potential for nickel toxicity.
Complications
The frequency of complications with percutaneous closure is low, manifesting in under 9% of all cases. With experienced, skilled clinicians, the rate of complication may be as low as 1%.[1]. Complications associated with percutaneous closure include:
Device Related
- Device embolization
- Malposition of the device
- Device erosion
Medical Complications
- Atrial fibrillation or supraventricular tachycardia
- Transient antrioventricular block/heart block
- Pericardial effusion
- Thrombus formation in the left atrial appendage
- Iliac vein dissection
- Groin hematoma
- Cardiac perforation
- Increased levels of cardiac tropnin I
- Residual shunts
- There can be migration or erosion of the device so follow-up is warranted.
Prognosis
The prognosis of percutaneous repair of atrial septal defect is generally good. However, the prognosis varies and depends on some factors like age at surgery, size of defect, amount of blood shunting and other associated co-morbidities at the time of repair. Some complications like pulmonary hypertension,eisenmenger’s syndrome, right sided heart failure, arrhythmias (atrial fibrillation, atrial flutter) and stroke can occur after the repair. However, these are common in older patients(>40years) compared to younger patients.
References
- ↑ Chessa M, Carminati M, Butera G, Bini RM, Drago M, Rosti L; et al. (2002). "Early and late complications associated with transcatheter occlusion of secundum atrial septal defect". J Am Coll Cardiol. 39 (6): 1061–5. PMID 11897451.