介入治疗和外科开胸手术治疗小儿室间隔缺损的临床效果对比

目的比较介入治疗与外科开胸手术治疗小儿室间隔缺损(VSD)的临床效果。方法选取2012—2014年在福建医科大学附属漳州市医院治疗的VSD患儿63例,根据患儿治疗方式不同分为介入治疗组(n=30)和外科开胸手术组(n=33)。介入治疗组患儿接受经导管室间隔缺损封堵术,外科开胸手术组患儿接受外科开胸手术。两组患儿术后7 d内均行超声心动图及心电图检查,术后随访6个月,比较两组患儿治疗情况(包括手术成功率、手术时间及术后住院时间)、术后残余分流发生情况及术后并发症(心律失常、新发瓣膜返流)发生情况。结果两组患儿手术成功率比较,差异无统计学意义(P0.05)。介入治疗组患儿手术时间和术后住院时间均短于外科开胸手术组(P0.05)。外科开胸手术组患儿术后残余分流、心律失常和新发瓣膜返流发生率均低于介入治疗组(P0.05)。结论介入治疗与外科开胸手术治疗VSD的临床效果相当,但外科开胸手术术后残余分流发生率低、并发症少,介入治疗操作时间短、创伤小、术后恢复快且术后不留瘢痕。     

膜周型室间隔缺损并发中、重度三尖瓣反流时行介入封堵的可行性分析

目的研究膜周型室间隔缺损并发中、重度三尖瓣反流时行介入封堵的治疗效果。方法入选膜周型室间隔缺损并发中、重度三尖瓣反流的患者43例(三尖瓣反流的原因均为右心室局部心腔压力增高所致),其中行导管介入封堵术组21例,外科修补手术组22例。术后三尖瓣反流程度(三尖瓣反流长度、三尖瓣反流面积、三尖瓣反流容积、三尖瓣反流速度、三尖瓣反流压差)、手术成功率、并发症发生率(严重并发症包括:心脏压塞、较大残余分流、开胸止血、恶性心律失常、封堵器移位、瓣膜损伤;次要并发症包括:一过性心律失常、切口愈合欠佳、心包积液、胸腔积液,心包切开综合征,无需处理的微量残余分流等)、术后住院时间(d)、住院总费用(万元)、手术时间(min)、正性肌力药物评分、术后第24小时白细胞计数、C反应蛋白(CRP)、心肌损伤标志物[血清心肌肌钙蛋白I(cTnI)、肌红蛋白(Myo)、肌酸激酶同工酶(CK-MB)]。随访时间为术后3～12个月,平均10个月。结果 (1)43例并发中、重度三尖瓣反流的膜周型室间隔缺损治疗均一次成功,无死亡病例。术后三尖瓣反流量较术前显著减少,部分病例反流即刻消失。两组中,每组手术术前与术后三尖瓣反流程度的差异均有统计学意义(P<0.05)。两组间术前与术后三尖瓣反流差值的差异无统计学意义(P>0.05)。介入封堵组在手术时间、术后血管活性药物、术后第24小时白细胞计数、CRP、心肌损伤标记物方面均优于外科修补手术组。在手术费用方面外科修补手术组略低于介入封堵组,但差异无统计学意义。手术住院天数两者差异无统计学意义。(2)外科修补手术组手术成功率100%,无严重并发症出现,次要并发症1例,为微量残余分流,无需处理。介入封堵组手术成功率100%,次要并发症1例,为主动脉瓣轻微反流,无需特别处理。(3)术后随访3～12个月,存活率为100%,均无并发症出现。结论术前经过认真的超声心动图评估,部分室间隔缺损并发三尖瓣中、重度反流的患者行介入治疗优于外科手术。     

高原地区经导管封堵治疗先天性心脏病的并发症及防治

目的:探讨高原地区经导管介入治疗先天性心脏病并发症及其防治.方法:对968例3种常见先天性心脏病患者施行了介入治疗,其中动脉导管(PDA)封堵组586例,房间隔缺损(ASD) 堵组340例,室间隔缺损(VSD)堵组42例,统计分析所有患者术中及术后发生的并发症,并对并发症的处理进行总结.结果:手术成功率98%,无死亡病例,严重并发症发生率1.55%(15/968),其中PDA封堵组1.0%(6/586),ASD封堵组1.8%(6/340),VSD封堵组7.1%(3/42).术中或术后一过性及短期并发症发生率0.62%(6/968),其中PDA封堵术组0.34%(2/586),ASD封堵组0.9%(3/340),VSD封堵组2.4%(1/42).结论:高原地区介入治疗具有操作简便易行、创伤小、风险小、安全可靠、技术成功率高、住院时间短等优点.     

高海拔地区老年患者房间隔缺损的介入治疗

目的探讨高原地区经导管介入封堵治疗老年患者房间隔缺损(ASD)的有效性和安全性。方法回顾性分析经导管封堵治疗的51例老年ASD患者的临床和介入治疗资料。结果全组治疗成功率90.2%,经胸超声心动图(TTE)测量ASD平均大小为(24.3±5.8)mm,封堵器平均大小为(28.2±8.6)mm,均采用国产封堵器。术后3个月平均肺动脉收缩压较术前下降明显(P<0.05),右心房、右心室内径较术前减小。微少量残余分流3例,3个月后复查分流消失。并发症发生率11.8%,无死亡。随访6⁴2个月,封堵器无移位,心功能改善。结论高原地区老年ASD患者有缺损大,肺动脉高压程度严重,并发症多的特点。严格掌握适应证,规范操作,积极治疗并发症,是成功封堵的关键。     

经皮导管介入封堵与外科微创封堵治疗室间隔缺损的对比研究

目的 比较经皮导管介入封堵与外科微创封堵治疗单纯室间隔缺损的疗效及优缺点,为临床治疗方案提供选择依据.方法 回顾性分析2007年3月至2011年1月在武汉亚洲心脏病医院选择封堵治疗的室间隔缺损病例138例,其中行经皮介入封堵治疗82例(介入组),同期行外科微创封堵治疗56例(外科组).比较两组的疗效、并发症及预后情况.结果 介入组82例中2例封堵失败,手术成功率97.6％.发生并发症12例,发生率14.6％.手术时间(30.18±18.24) min,术后住院时间(6.88±0.35)天,住院费用(3.01±0.11)万元.外科组56例微创封堵成功49例,手术成功率88％,7例术中封堵失败转常规开胸手术,发生并发症29例,并发症发生率51.8％,手术时间(79.87±23.58)min,术后住院时间(6.72±1.05)天,住院费用(3.26±0.23)万元.随访2～12个月,两组均无死亡病例.结论 两种治疗方法均可有效地治疗单纯室间隔缺损.经皮介入封堵治疗手术时间短,创伤小,并发症少,费用低,不用输血.外科微创封堵无需照射放射线,可在术中随时改变治疗方案.     

四种方法治疗继发孔房间隔缺损的比较

目的:分析比较四种方法治疗继发孔房间隔缺损(ASD)的病历资料,探讨各自的最佳适应征,提高手术成功率,兼顾美容。方法:回顾性分析南京医科大学第二附属医院2016年3月1日至2017年5月31日期间,住院治疗的81例继发孔ASD患者的临床资料,按手术方法的不同分为四组:经皮导管介入封堵组(A组12例);经胸微创封堵组(B组23例);完全电视胸腔镜体外循环心内直视手术组(C组17例);右腋下小切口体外循环心内直视手术组(D组29例)。比较四组的手术时间、术后恢复时间、术后胸引量、总输血量、手术成功率、并发症发生情况等。结果:A、B两组手术时间、术后恢复时间、术后胸引量、总输血量均明显短或少于C、D两组;手术创伤也明显轻于C、D两组,且没有体外循环缺血缺氧性损伤。A、B两组手术切口明显短于C、D两组、美容效果好(尤其是A组),但ABC三组均有病例手术失败中转传统胸骨正中切口外科手术。除D组1例病情过重死亡外,其余三组均无死亡; D组手术成功率最高、适应证最广。结论:四种方法都能安全有效的治疗继发孔ASD; A、B两组在多方面优于C、D两组,尤其美容效果佳。D组手术成功率最高、适应证最广。各级医疗单位可根据各自的实际外科能力,结合患者病情、年龄及美容要求,选择切实安全可行的方法,减少并发症、兼顾美容。     

先天性心脏病介入治疗与外科治疗临床比较

目的:对房间隔缺损(ASD)、室间隔缺损(VSD)的介入治疗(Amplatzer封堵器)和外科手术治疗的临床疗效进行比较。方法:2004年5月至12月住院患儿,符合单一左向右分流畸形ASD或VSD,根据治疗方法不同分为介入组和手术组;比较2组在疗效、费用、并发症、输血量及住院时间等方面的异同;通过放免法测定2组治疗前后的心钠素(ANP)水平。结果:2组手术成功率均为100%;介入组均未输血,手术组均输血治疗(P<0·01);术后住院时间介入组少于手术组(P<0·01);治疗费用介入组高于手术组(P<0·01);ANP水平、外科手术及介入治疗后均较治疗前降低。结论:单一ASD、VSD的介入治疗与手术治疗临床效果相同;介入组不需输血,术后住院时间短,但治疗费用较昂贵。     

大孔型房间隔缺损封堵治疗的疗效和安全性

目的探讨经导管介入治疗大孔型房间隔缺损(ASD)的疗效和安全性。方法选择经胸超声心动图确诊的大孔房间隔缺损患者46例,年龄8~71岁,平均37.6岁。术前超声心动图检查ASD最大直经25~38(30±8)mm,术前心功能(NYHA分级)Ⅱ级15例,Ⅲ级5例,其中肺动脉平均压力>25mmHg者28例,封堵前肺动脉压力(32±8.2)mmHg。所有患者均在局麻下,应用X光透视,和经胸心脏超声引导下经导管置入国产封堵器,封堵ASD,对部分ASD残端薄弱者采用“肺静脉法”操作技术完成封堵。结果44例封堵成功,技术成功率95.6%。选择封堵器直经为30~42mm,封堵后肺动脉压降低至(18.4±5.8)mmHg。术中未发生任何重要并发症,无急诊手术病例。失败2例患者ASD伸展径分别为36mm和38mm,缺损后缘缺乏有效房隔组织。术后即刻超声显示6例仍存在微量至少量残余分流,分流束直径小于4mm;术后6月超声心动图检查时无1例残余分流,房间隔封堵器位置稳定。术后6~38个月随访,右心房、右心室缩小,心功能明显改善。无封堵器相关并发症。结论国产封堵器介入治疗大孔房间隔缺损具有操作简便、安全、费用低、技术成功率高及封堵效果好等优点。     

开胸手术与胸腔镜手术治疗非小细胞肺癌临床效果的比较研究

目的比较开胸手术与胸腔镜手术治疗非小细胞肺癌的临床效果。方法选取西安交通大学第一附属医院2005年1月—2010年2月收治的非小细胞癌患者180例,根据手术方式分为开胸手术组和胸腔镜手术组,每组90例。开胸手术组患者行传统开胸手术,胸腔镜手术组患者行胸腔镜手术。比较两组患者手术情况(术中出血量、淋巴结清扫数目、术后引流量、置管时间、住院时间)、复发及转移情况、5年生存率、FACF-L中文4.0版调查表评分、手术前后免疫功能指标(血清Ig G、Ig A、Ig M水平及CD+3、CD+4、CD+8细胞分数)及并发症发生情况。结果胸腔镜手术组患者术中出血量、术后引流量小于开胸手术组,置管时间及住院时间短于开胸手术组(P0.05);而两组患者淋巴结清扫数目比较,差异无统计学意义(P0.05)。胸腔镜手术组患者复发时间长于开胸手术组,远处转移率低于开胸手术组(P0.05);而两组患者复发率比较,差异无统计学意义(P0.05)。胸腔镜手术组患者5年生存率为44.4%,开胸手术组为41.1%,差异无统计学意义(P0.05)。胸腔镜手术组患者FACF-L中文4.0版调查表生理状况评分、功能状况评分、附加肺癌相关因素评分及总分高于开胸手术组(P0.05);而两组患者社会状况评分、情感状况评分比较,差异无统计学意义(P0.05)。两组患者术前血清Ig G、Ig A、Ig M水平及CD+3、CD+4、CD+8细胞分数比较,差异均无统计学意义(P0.05);胸腔镜手术组患者术后血清Ig G水平及CD+3、CD+4、CD+8细胞分数均高于开胸手术组(P0.05);而两组患者术后血清Ig A、Ig M水平比较,差异均无统计学意义(P0.05)。胸腔镜手术组患者并发症发生率为12.2%,低于开胸手术组的35.6%(P0.05)。结论与传统开胸手术相比,胸腔镜手术治疗非小细胞肺癌具有创伤小、住院时间短、康复速度快、并发症少、对免疫功能影响小等优点,在保证淋巴结清扫效果和生存期的前提下有利于提高患者术后生活质量,降低术后远处转移率及延长复发时间。     

环肺静脉前庭电隔离对房间隔缺损合并心房颤动患者治疗方法学和疗效评价

目的:探讨采用环肺静脉前庭电隔离(CPVA)治疗房间隔缺损(ASD)合并心房颤动的方法学及临床疗效. 方法:8例ASD合并持续性房颤患者,其中男5例,女3例,平均年龄(48.7±17.6)岁,2例为拟行ASD修补或封堵术患者,6例为ASD修补术后患者,均采用三维电解剖标测系统(CARTO)指导下环肺静脉消融,消融终点为肺静脉电隔离. 结果:8例患者均实现术中消融终点,1例ASD患者CPVA术后行封堵术,1例患者术后行外科手术;1例ASD修补术后患者CPVA术后1个月房颤复发,再次采用CARTO指导下环同侧肺静脉的线性消融.手术时间为145～235 min,平均(180±30)min;X线曝光时间为18～32 min,平均(25±5)min.术中及术后未发生任何操作相关并发症,随访1～6个月房颤无复发. 结论:CPVA对ASD合并房颤患者有较好的临床疗效,对ASD合并房颤患者可首先考虑CPVA治疗,然后再进行介入封堵.     

Strategy of treating secundum atrial septal defect not referred to percutaneous closure

Objective: To evaluate safety and effectiveness of intraoperative device closure for secundum atrial septal defect (ASD) not referred to percutaneous closure.
Design and Patients: From April 2010 to December 2018, 231 secundum ASD children (≤14 years) directly recommended to surgical repair were enrolled in this study. These patients were divided into two groups according to the parents’ choice based on surgeons’ recommendation. Follow-up evaluations were adopted at 2 weeks, 3 months, 6 months, and 12 months after the procedure and yearly thereafter. In Group A, 127 patients underwent an initial attempt at device closure. In Group B, 104 patients underwent a repair procedure under cardiopulmonary bypass.
Results: All patients survived. Group A had lower values of operation time, mechanical ventilation time, cardiac intensive care unit duration and amount of blood transfusion. Nevertheless, postoperative hospitalization time between two groups showed no statistical difference. In group A, 109 (85.83%) patients were successfully occluded, whereas 18 (14.17%) patients were converted to open-heart surgery. No severe complications occurred in the follow-up period.
Conclusion: Intraoperative device closure is safe, effective procedure for selected cases with secundum ASDs which were not referred to percutaneous closure because of more suitable occluder selection, no “unbutton effect” and stitching enhancement.     

Closure of atrial and ventricular septal defects should be performed by the surgeon

Surgeons look back on 57 years of experience in the closure of atrial septal defects (ASDs) and 46 years in the closure of ventricular septal defects (VSDs). The transcatheter approaches to repair ASDs started first in the 1980s and for VSDs 8 years later. This study sought to reveal the surgical features only given by the surgical therapy and the limitation of interventional ASD and VSD closure. A variety of surgical techniques including the minimal invasive techniques for ASD or VSD closure are well described in recent publication with good results. The surgical trend is to improve the cosmetic outcome by minimizing the size of skin incision. The latest robotically assisted technique requires only four stab wound incisions. New techniques and devices have revolutionized the transcatheter technique but could not achieve the surgical ability to close all types of ASD or VSD, control arrhythmias, and correct additional valve disease or malformation. The mortality for interventional and surgical procedures approaches zero in recent publication. The residual shunting after surgical closure of ASD varies from 2% to 7.8% versus 5% to 33% after interventional closure. General complications caused by the surgical procedure are negligible; however, the shortness of hospital stay and the cosmetic appeal is an advantage of interventional ASD closure. There is no scientific comparison of surgical vs. interventional VSD closure yet.     

成人继发孔型房间隔缺损并发房颤患者三种治疗方法分析

目的介绍成人房间隔缺损（ASD）并发心房颤动（AF）患者的几种治疗方法,并分析其治疗效果。方法：回顾分析本院136例ASD并发有明显临床症状且药物治疗无效的AF病例,其中36例接受介入封堵＋经导管射频消融术（导管射频消融组）,84例体外循环下ASD补术＋改良迷宫术（改良迷宫组）,16例单纯介入封堵术（未行经导管射频消融术,单纯介入封堵组）,术前,术后12月用心脏超声仪评价右心房、右室内径及肺动脉压力和心电图变化。结果：所有病例的术中、术后均未出现严重并发症,所有病例均无死亡,随访12个月,36例接受介入封堵＋经导管射频消融术28例转复为窦性心律,8例仍为AF,后行二次射频消融术转为窦性心律,84例ASD补术＋改良迷宫手术患者中有66例转复窦性,14例失败仍为AF,4例为交界性心律,单纯介入封堵组16例8例成功,8例术后仍为AF,与术前比较,各组心脏超声检查示右心房、右心室内径均较术前明显缩小,肺动脉压力明显下降（均P〈0．05）。各组之间无显著差异。经导管射频消融组和改良迷宫手术组AF治愈率高（对比单纯介入组,均P〈0．05）,患者心慌不适更能得到改善,生活质量更高。结论：介入封堵及外科手术均能安全有效治疗ASD并发AF,每种方法各有利弊,可依据患者临床具体情况选择。     

Iatrogenic cardiac arrhythmias following transcatheter or surgical closure of atrial septal defect in children

BACKGROUND: Invasive procedures involving the atria may promote the development of iatrogenic cardiac arrhythmias. AIM: To analyse the prevalence of cardiac arrhythmias following transcatheter or cardiosurgical closure of the secundum type atrial septal defect (ASD). METHODS: The study group consisted of 91 patients, aged 2-18 years with haemodynamically significant ASD who underwent surgical (n=44) or transcatheter (Amplatzer occluder) (n=47) closure of ASD. Standard ECG and Holter ECG recordings, obtained before and after the procedure, were analysed. The follow-up duration ranged from 2.5 to 5.5 years. Cardiac arrhythmias were divided into benign or significant (requiring pharmacological therapy), early or late, and transient or permanent. RESULTS: Cardiac arrhythmias were detected in 16 (36%) patients who underwent surgery compared with 1 (2.1%) patient who underwent transcatheter ASD closure (p<0.05). In surgically treated patients, arrhythmias were benign in 9 patients, significant in 7 children, early in 15 subjects, late in one patient, transient in 13 children and permanent in 3 subjects. One patient, who underwent transcatheter ASD closure, developed paroxysmal supraventricular tachycardia one day after the procedure, successfully terminated with verapamil. CONCLUSIONS: Transcatheter closure of ASD is associated with a lower risk of procedure-related arrhythmias than surgical treatment. However, longer follow-up in patients treated with transcatheter procedure is needed in order to draw definite conclusions.     

儿童房间隔缺损介入术前后凝血机能的变化

目的探讨儿童房间隔缺损(ASD)介入治疗封堵器植入前后凝血机能的变化及ASD介入治疗的安全性。方法采用酶联免疫吸附法(ELISA)检测19例儿童ASD患者介入封堵前后血浆凝血酶原片段1+2(F1+2)、β-血小板球蛋白(β-TG)、血浆组织型纤溶酶原激活物(t-PA)、D二聚体(D-dimer)浓度。结果与封堵术前比较,血浆F1+2、t-PA、D-dimer浓度术后即刻明显升高,术后1日较术前水平仍高,但差异无统计学意义,术后1个月基本恢复至术前水平;β-TG术后即刻明显升高,术后1天基本恢复至术前水平。结论儿童ASD介入封堵术后出现了凝血酶、纤溶系统的激活及血小板的活化,短期内恢复至术前水平;儿童ASD介入术后使用阿司匹林抗凝已足够;介入治疗ASD安全、有效。     

介入治疗房间隔缺损600例临床分析

目的:探讨介入治疗房间隔缺损(ASD)的疗效及并发症。方法:1998年11月至2011年2月应用双盘伞ASD封堵器治疗600例继发孔ASD,其中男性235例,女性365例;年龄1.3~72岁,体质量10~107kg。术前均经体检、心电图、胸X线片及超声心动图确诊,术后行心脏超声及临床检查随访。结果:手术成功率98.8%(593/600),5例因缺损较大或边缘不足试封堵失败,1例术中出现Ⅲ°房室传导阻滞放弃介入治疗,1例释放封堵器后即发现移位,即刻通知外科及时开胸取出封堵器并修补缺损;选择封堵器直径6~40mm,35例多孔ASD,有33例置入1个封堵器,2例应用2个封堵器。手术近期并发症包括:封堵器移位(1例),脑梗死(1例),心律失常(2例),空气栓塞(3例),平均5年随访中没有严重并发症。结论:ASD的介入治疗其技术成功率高,近期和远期疗效均满意,已成为治疗ASD的首选方法。     

Complications Related to Transcatheter Occlusion of Atrial Septal Defect with Amplatzer Septal Occluder in Children

METHODSPatients From August 1998 to March 2004, a total of 289 children (mean age: 6.5 ±3.8 years) have undergone transcatheter occlusion of secundum type ASD with ASO. All cases performed transthoracic echocardio- graphy (TTE) evaluation before implantation and con- finned by balloon sizing in interventional procedure, partly confirmed by transoesophageal echocardiography(TEE). Patients with a residual rim of atrial septum <4mm, or diameter of ASD + 14mm > the maximal septal length…     

Perforation of the aorta after percutaneous closure of an atrial septal defect with an Amplatz prosthesis,presenting with acute severe hemolysis

We report a case of aortic perforation three weeks after transcatheter occlusion of an atrial septal defect (ASD) by an Amplatzer device. Revealed by acute hemolysis, this complication needed an emergency surgical operation. The fistula between the no coronary Valsalva sinus of the aorta and the left atrium was repaired. The ASD was closed by patch. This serious accident should consider a short antero-superior rim as a risk factor for aortic perforation in transcatheter closure for ASD.     

房间隔缺损介入治疗封堵器的选择对心脏重构的影响

目的 探讨经导管介入封堵术治疗继发孔型房间隔缺损(ASD)的封堵器选择对其疗效及心脏形态学重构的影响.方法 入选146例ASD患者,年龄13.5～70.0(33.5±12.4)岁.其中73例(A组)根据椭圆周长数学公式计算缺损直径选择封堵器型号,另外73例(B组)根据超声心动图测量长径选择封堵器型号.应用经胸超声心动图分别测量ASD患者经导管封堵治疗术前、术后3 d、3个月和6个月的左心房收缩末期横径(LALD)、右心房横径(RALD)、RALD/LALD比值、右心室舒张末期内径(RVDD)、左心室舒张末期内径(LVDD)、RVDD/LVDD比值及肺动脉内径.结果 A组缺损内径为(20.16±4.98)mm,B组为(21.36±5.69)mm,差异无统计学意义.封堵器直径A组小于B组[(21.95±6.78)mm比(25.85±6.75)mm,P<0.05].142例封堵术成功,两组成功率差异无统计学意义,无主要手术相关并发症发生.随访6个月无残余分流发生.两组患者随访期间RALD、RVDD、RALD/LALD和RVDD/LVDD比值明显下降,肺动脉内径逐渐缩小,LALD、LVDD逐渐增大.A组改善心房重构程度明显大于B组(P<0.05).结论 椭圆形周长公式在非圆形ASD封堵器选择中具有重要应用价值;封堵器大小对心脏重构有明显影响.     

Early and late complications associated with transcatheter occlusion of secundum atrial septal defect

OBJECTIVES: The goal of this study was to report the early and late complications experienced in atrial septal defect (ASD) transcatheter closure. BACKGROUND: Atrial septal defect transcatheter occlusion techniques have become an alternative to surgical procedures. A number of different devices are available for transcatheter ASD closure. The type and rate of complications are different for different devices. METHODS: Between December 1996 and January 2001, 417 patients (mean age: 26.6 +/- 19 years) underwent transcatheter occlusion of secundum type ASD. Complications were categorized into major and minor. Two different devices were used: the CardioSEAL/STARFlex in 159 patients and the Amplatzer septal occluder in 258 patients. RESULTS: Thirty-four patients experienced 36 complications during the hospitalization (8.6%, 95% confidence interval: 6.1% to 11.1%). Ten patients underwent elective surgical repair because of device malposition (three patients) or device embolization (seven patients). Twenty-four patients experienced 25 minor complications: unsatisfactory device position or embolization. Devices were retrieved using a gooseneck snare and/or a basket; 11 patients experienced arrhythmic problems. Other complications were: pericardial effusion, thrombus formation on the left atrial disc, right iliac vein dissection, groin hematoma, hemorrhage in the retropharynx and sizing balloon rupture. Two patients had late complications: peripheral embolization in the left leg one year after implantation of an Amplatzer device and sudden death 1.5 year later. CONCLUSIONS: Our series of patients with ASD by transcatheter occlusion shows that the procedure is safe and effective in the vast majority of cases. To further reduce the complications rate, the criteria of device selection according to ASD morphology and some technical tips during implantation are discussed.