The following factors are critical determinants of the success of ASD device closure
- Location of the defect ( Only ostium secundum )
- Size of the defect (<35mm .Never forget simple truth , larger the defect shorter would be the rim )
- Shape of the defect (Please note ,none are strictly circular but most devices are ! )
- Eccentricity of the defect (RA aspect of ASD need not match LA aspect)
- Length of the rim ( 5mm said to be adequate)
- Thickness of the rim ( Least respected parameter .Thin filament like rims are notorious in sagging the device into RA)
- Pre and Per- operative TEE (As Vital as the procedure)
- Technical expertise . (This includes extreme patience of the primary operator .Most sub optimal results and complications are related to this.
- Good team ( Not every interventional cardiologist should attempt this !)
- Courage to abandon the procedure
- Device brand (Probably less important )
Dr.S.Venkatesan MD 
Leave a Reply