title: Device closure of secundum atrial septal defects in children <15 kg: complication rates and indications for referral.
abstract: OBJECTIVE
  This study sought to determine institutional complication rates in a previously underreported patient population and discuss referral indications.
  
  
  BACKGROUND
  There has been a trend over the years for referral of younger and smaller patients for "elective" closure of atrial septal defects (ASD). In general, the risks associated with ASD device closure are believed and reported to be relatively low. Complication rates in this group of smaller patients are not well described in the literature for either percutaneous or surgical approaches.
  
  
  METHODS
  Retrospective review of all patients who underwent elective transcatheter closure of secundum ASD between March 2000 and April 2010. We excluded all children >15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated.
  
  
  RESULTS
  We identified 128 patients meeting criteria with a median procedural age of 1.92 years (3 months to 4.92 years), and median weight of 10.8 kg (4.3 to 14.9 kb). There were 7 major (5.5%) and 12 minor (9.4%) complications. Nearly two-thirds of referrals were for right heart enlargement or poor growth. Rate of resolution of residual shunt was 99%. When compared with age, there was no difference in the rate of resolution of right heart enlargement. No clinically significant improvement in growth was observed.
  
  
  CONCLUSIONS
  Transcatheter ASD closure in small children is highly successful, but with an increase in previously perceived complication rates. In small, asymptomatic patients, deferral of closure until the historically established timeline of around 4 to 5 years of age should be strongly considered.
authors.affiliation: Division of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, Denver, CO, USA. sbartakian@rchsd.org
authors.forename: Sergio
authors.initials: S
authors.lastname: Bartakian
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Fagan
authors.forename: Michael S
authors.initials: MS
authors.lastname: Schaffer
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Darst
mesh_terms: D001835:Body Weight; D002675:Child, Preschool; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012017:Referral and Consultation; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000009:adverse effects*