title: Open-chest device closure for the minimally invasive management of atrial septal defect in young children.
abstract: BACKGROUND
  We integrated a catheter-based device and minimally invasive surgical techniques for the treatment of atrial septal defect for children younger than 2 years old.
  
  
  METHODS
  Forty-three patients were divided into 3 groups: group A underwent open-chest device closure with a right lateral thoracotomy (n = 12), group B underwent open-heart repair with a right lateral thoracotomy and cardiopulmonary bypass (n = 11), and group C underwent open-heart repair with a median thoracotomy and cardiopulmonary bypass (n = 20).
  
  
  RESULTS
  Group A had the lowest weight (9.25 +/- 1.3 kg) and smallest defect size (10.25 +/- 3.9 mm). In group A, 2 patients had to be transitioned to open-heart repair after unsuccessful occlusion. Compared with the open-heart groups, the device group had a shorter total operation time (111 +/- 39 minutes), required the minimum amount of blood products (39 +/- 38 mL), and had a smaller amount of pleural drainage in the first 12 hours after the procedure (29 +/- 12 mL). All patients were discharged. The right ventricular end-diastolic diameter reduced significantly after the repair; furthermore, there was no difference in the size of reduction. However, the device group had the highest medical costs (30,639 +/- 3831 Chinese yuan). During the follow-up, there were no occluder-related complications observed in Group A, and there were no residual shunts or arrhythmia observed in the groups.
  
  
  CONCLUSIONS
  The open-chest device closure was safely performed as a supplement for percutaneous treatment for young children.
authors.affiliation: Center for Pediatric Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: Shou-jun
authors.initials: SJ
authors.lastname: Li
authors.forename: Yong-qing
authors.initials: YQ
authors.lastname: Li
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Sheng-shou
authors.initials: SS
authors.lastname: Hu
mesh_terms: D000367:Age Factors; D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D002675:Child, Preschool; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D013908:Thoracotomy / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome