title: Single pediatric center experience with multiple device implantation for complex secundum atrial septal defects.
abstract: OBJECTIVE
  We analyzed the efficacy and complications of placing multiple transcatheter devices to correct complex ASD in a primarily pediatric population.
  
  
  BACKGROUND
  Limited pediatric information exists regarding the safety and efficacy of using multiple devices for secundum atrial septal defects (ASD) when multiple defects are present.
  
  
  METHODS
  Cath lab, echo, and clinical data were reviewed for 238 patients who underwent device closure of secundum ASD from 2000 to 2007 at a single pediatric center. Of those requiring multiple devices (n = 15), residual shunting and complications were assessed.
  
  
  RESULTS
  238 patients (mean age 12 yrs; 80% < 16 yrs) underwent transcatheter ASD closure. 34 (14%) had multiple ASD, but only 15 received multiple devices (2 devices in 14 and 3 devices in 1). The mean age and weight (12 yrs; 35 kg) represent a younger population than previously reported. Only 3 were > 15 yrs, with a median age of 10.8 yrs (range 2-31). There was no compromise or obstruction to surrounding structures, and no device embolization or erosion was noted. A tiny thrombus was observed on the right sided screw of one device with no clinical sequelae. One patient (age 31 yrs) died at home 30 days post procedure from cardiac tamponade. Autopsy revealed the 3 intact devices in stable position without evidence of erosion. Latest available echo follow-up for the group revealed functional resolution of atrial level shunting in all patients.
  
  
  CONCLUSIONS
  Multiple devices can safely and effectively be implanted in the pediatric population to close complex ASD.
authors.affiliation: Pediatric Cardiology, Riley Hospital for Children, Indiana University, Indianapolis, Indiana 46202, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Bramlet
authors.forename: Mark H
authors.initials: MH
authors.lastname: Hoyer
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D004867:Equipment Design; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D016896:Treatment Outcome