Midterm results of percutaneous closure of very large atrial septal defects in children: role of multislice computed tomography.
OBJECTIVE
The aim of this study was to assess the midterm results of percutaneous closure of very large atrial septal defects (ASD) in children with transthoracic echocardiography (TTE) and multislice computed tomography (MSCT).


RESULTS
Among 142 children who underwent percutaneous ASD closure with the AMPLATZER® Septal Occluder (ASO) (AGA Medical Corporation, Plymouth, MN, USA) during an eight year period, 51 patients with very large defects, were evaluated by TTE and MSCT after a period of at least two years following ASD closure. Median age at ASD closure was six years (range 4-10), with mean ASD size 20.9±2.9 mm. Median device size was 20 mm (range 15-26) and median device: septal length ratio 0.95 (range 0.8-1). Early complications included one transient complete atrioventricular block and one device embolisation. At a median follow-up of 55 months (range 25-92) all patients were clinically asymptomatic and had a normal ECG. TTE did not demonstrate device protrusion across the lumen of either the systemic or pulmonary veins. The mean device: septal length ratio had decreased from 0.96±0.05 to 0.8±0.02 (p<0.001). There was good correlation between the measure of atrial septum length by TTE and MSCT (r: 0.79, p<0.001). MSCT identified moderate dynamic device protrusion into the lumen of systemic or pulmonary veins in five patients and partial device malpositioning in two patients.


CONCLUSIONS
Occlusion of very large ASD in children can be performed with low complications rate. MSCT provides detailed information regarding the location of the device with respect to surrounding anatomic structures and reveals anomalies not evident by TTE.
Ospedale Infantile Regina Margherita, Torino, Italy.
Davide
D
Marini
Phalla
P
Ou
Younes
Y
Boudjemline
Damien
D
Kenny
Damien
D
Bonnet
Gabriella
G
Agnoletti
D002648:Child; D004452:Echocardiography; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D061330:Multidetector Computed Tomography / Q000379:methods*; D055989:Septal Occluder Device / Q000009:adverse effects