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J Thorac Cardiovasc Surg 2000;120:1034-1039
© 2000 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale

From the Swiss Cardiovascular Center Bern^a and the Division of Pediatric Cardiology,^b University Hospital, Bern, Switzerland.

Address for reprints: Pascal A. Berdat, MD, Clinic for Cardiovascular Surgery, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland (E-mail: pascal.berdat{at}insel.ch).

Objective: During recent years, transcatheter closure has become an alternative to operations for the treatment of atrial septal defects and patent foramen ovale. However, this procedure may be unsuccessful or complicated and requires surgical treatment.
Methods: We retrospectively analyzed the outcomes of patients who needed surgical treatment after failed or complicated transcatheter closure of an atrial septal defect or a patent foramen ovale.
Results: Between April 1994 and March 1999, 124 patients were treated with transcatheter closure of an atrial septal defect or a patent foramen ovale at our institution. We report the results of 10 (8%) patients of this series who required operations after transcatheter closure attempts. In 8 of these 10 patients a significant shunt caused by malposition or dislocation of the device persisted, leading to surgical closure of the defect. In 2 patients injury of the femoral artery at the puncture site required surgical repair. In one patient the device had to be removed surgically from the iliac vein after retraction. One patient died of left ventricular perforation after dislocation of the device and several surgical attempts to close the left ventricular rupture. All other patients recovered well.
Conclusion: An operation was required after transcatheter closure of an atrial septal defect or a patent foramen ovale in 8% of patients. After device complications, the atrial septal defect and the patent foramen ovale can still successfully be closed surgically with good results and low morbidity. However, serious complications like cardiac perforation may have a fatal outcome. Residual shunt, dislocation, or vascular complications are the most frequent problems that require surgical interventions.

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