title: Transcatheter closure of atrial septal defect in young children: results and follow-up.
abstract: OBJECTIVE
  This study sought to analyze the safety, efficacy, and follow-up results of percutaneous closure of secundum atrial septal defect (ASD) in young children.
  
  
  BACKGROUND
  Results of ASD transcatheter closure in adults are widely reported but there are no large published series concerning young children.
  
  
  METHODS
  Between December 1996 and February 2002, 48 of 553 patients percutaneously treated at our institution were children age <or=5 years. Indications for closure were: elective closure in 32 patients; frequent respiratory infections in 8; failure to thrive in 2; liver transplantation in 5; and a fenestrated Fontan in 1. The procedure was carried out under general anesthesia with fluoroscopy and transesophageal control. Two different devices were used: 1) the CardioSEAL/StarFLEX (CS/SF) and 2) the Amplatzer septal occluder (ASO). Basal physical examinations and echocardiograms were performed prior to the procedure and at follow-ups (1, 6, and 12 months, and yearly thereafter).
  
  
  RESULTS
  The mean age at closure was 3.6 +/- 1.3 years. A CS/SF was used in 10 subjects; an ASO was used in 38 patients. No deaths or immediate major complications occurred. The total occlusion rate was 87% at procedure, rising to 94% at discharge. The mean follow-up was 18 +/- 14 months. No midterm major or minor complications occurred. The occlusion rate rose to 100% at 12 months of follow-up. Symptomatic patients improved significantly.
  
  
  CONCLUSIONS
  In the current era and in experienced hands, ASD closure can be performed safely and successfully, even in very young children.
authors.affiliation: Pediatric Cardiology Department, Istituto Policlinico San Donato, San Donato Milanese, Italy. gianfra.butera@lycos.com
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Butera
authors.forename: Gabriella
authors.initials: G
authors.lastname: De Rosa
authors.forename: Massimo
authors.initials: M
authors.lastname: Chessa
authors.forename: Luca
authors.initials: L
authors.lastname: Rosti
authors.forename: Diana Gabriella
authors.initials: DG
authors.lastname: Negura
authors.forename: Piazza
authors.initials: P
authors.lastname: Luciane
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Mario
authors.initials: M
authors.lastname: Carminati
mesh_terms: D000367:Age Factors; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods*; D005183:Failure to Thrive / Q000209:etiology; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation; D008297:Male; D018579:Patient Selection; D011669:Pulmonary Wedge Pressure; D012141:Respiratory Tract Infections / Q000209:etiology; D012449:Safety; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*