Transcatheter closure of secundum atrial defect in small children.
OBJECTIVE
To assess safety and efficacy of transcatheter atrial septal defect (ASD) closure in small children.


BACKGROUND
Percutaneous closure of ASD is a well accepted alternative to surgery. Reported experience in small children remains, however, scarce.


METHODS
Fifty-two children underwent percutaneous ASD closure at a weight < or =15 kg, in four Belgian tertiary referral paediatric cardiology centers. Indication for treatment, device implantation rate, procedural details, complication rate, residual shunt on echocardiography, and impact of procedure on symptoms were retrospectively analyzed.


RESULTS
Mean age at procedure was 36 months (7-60), mean weight 13 kg (4.7-15). Associated cardiac lesions were seen in 21% of the patients and noncardiac in 32.7%. Most patients (69.2%) were symptomatic. Mean ASD size was 12 mm (range 5-20 mm). A device could be inserted in 49 patients (94%). No major complications occurred. Minor complications occurred in 8 patients (15.4%) including device embolization in 2, successfully treated with transcatheter retrieval and second device insertion. Mean follow-up reached 27 months (0.03-61.2). Residual shunt was absent, trivial, or small in 93% (n = 42) at latest follow-up. Clinical improvement was noted in 91.7% of the symptomatic patients. Minor complications were more frequent in the presence of large ASDs (>15 mm) but not in smaller babies (<10 kg).


CONCLUSIONS
Patients < or =15 kg requiring ASD closure form a special population with high incidence of associated anomalies and medical conditions. For this particular set of patients, percutaneous closure is a valid alternative. Asymptomatic or mildly symptomatic children should be treated at a later age.
Cardenas
L
L
Department of Paediatric Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
Panzer
J
J
Boshoff
D
D
Malekzadeh-Milani
S
S
Ovaert
C
C
D001530:Belgium; D006328:Cardiac Catheterization / Q000009:adverse effects; D002675:Child, Preschool; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012107:Research Design; D012189:Retrospective Studies; D016896:Treatment Outcome