Deficiency of aortic rim an important risk factor for cardiac erosion with ASD device
Cardiac erosion is a potential nightmare of device closure of atrial septal defect (ASD) device closure, though exceedingly rare. Recent study published in Circulation  documented 125 erosions over a period of 12 years from a database. Erosions were diagnosed over a median of 14 days after the device closure. Deficiency of aortic rim was found to be almost universal while deficiency of any of the aortic, superior vena caval or inferior vena caval rims were the most important risk factor for cardiac erosion. The study was a case control study with age and sex matched controls. Device oversizing also contributed to the chance for cardiac erosion after ASD device closure. Those who died of the cardiac erosion were more likely to have aortic erosion than the survivors and an oversized device. Though the median period was 14 days, 16 of the 125 erosions were diagnosed after one year. Other factors related to erosion were larger size of the ASD, larger size device size, smaller weight:device size ratio and more than 5 mm difference between ASD size and device size.