title: Transcatheter closure of secundum atrial septal defect in infants less than 12 months of age improves symptoms of chronic lung disease.
abstract: OBJECTIVE
  Device closure of secundum type atrial septal defects in young children has now become common with extension of this practice to children less than 1 year of age. We hypothesized that patients less than 12 months of age with moderate increases in pulmonary blood flow due to atrial septal defects may improve clinically with device closure, particularly premature infants with chronic lung disease.
  
  
  METHODS
  Thirteen patients under 12 months of age have undergone atrial septal device closure at our institution from March 2002 to July 2008, with evidence of a left to right shunt by pre-procedural echocardiogram. We evaluated concomitant conditions and device closure results. Patient charts from follow-up visits with referring pediatric cardiologists were also reviewed. Follow-up phone interviews were conducted with parents/guardians of patients who underwent device closure to further evaluate clinical change.
  
  
  RESULTS
  The patient ages ranged from 3-11 months (median 7) with weight ranges of 2.9-8.3 kg (median 6.5). Defect sizes ranged from 5-15 mm (median 9). Concomitant conditions included prematurity with bronchopulmonary dysplasia (n = 8) and concern of elevated pulmonary artery pressures (n = 5). The median Qp : Qs was 1.6 with a range of 1 to 2.6. The mean pulmonary artery pressures ranged from 16 to 55 mm Hg (median 27). Eleven of 13 patients showed significant improvement in their clinical status, with a reduction in oxygen requirement (six patients) and reduced right heart pressures by echocardiogram (four patients). There were no residual defects on follow-up echocardiograms.
  
  
  CONCLUSIONS
  Transcatheter closure of atrial septal defects in infants can be safe, effective, and may be indicated for situations in which the left to right shunt may be implicated as a cause of ongoing chronic lung disease. Moderate increases in pulmonary blood flow due to atrial septal defects may have a negative clinical impact regarding continuing respiratory insufficiency in these patients.
authors: Emory University Children's Healthcare of Atlanta, Pediatric Cardiology, 1405 Clifton Road NE, Atlanta, Georgia, USA. vthomas@childrensheartcenter.com
authors: Vincent C
authors: VC
authors: Thomas
authors: Robert
authors: R
authors: Vincent
authors: Anthony
authors: A
authors: Raviele
authors: Helen
authors: H
authors: Diehl
authors: Holly
authors: H
authors: Qian
authors: Dennis
authors: D
authors: Kim
mesh_terms: D000367:Age Factors; D006328:Cardiac Catheterization / Q000295:instrumentation; D002908:Chronic Disease; D065627:Familial Primary Pulmonary Hypertension; D005845:Georgia; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D007223:Infant; D008171:Lung Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography