title: Large Amplatzer atrial septal occluder in growing children: an echographic study.
abstract: BACKGROUND
  Lesions of adjacent structures have been reported after closure of large atrial septal defects with the Amplatzer septal occluder. In children, growth of the heart should modify the initial relationship between the device and surrounding structures.
  
  
  OBJECTIVE
  To compare the relationship between large Amplatzer septal occluder and adjacent cardiac structures at short-, mid-, and long-term follow-up in at-risk paediatric population using echocardiography.
  
  
  METHODS
  A total of 25 children (4.6±2.9 years old, 18 girls) with the largest atrial septal defect devices implanted between 1997 and 2002 were enrolled prospectively for complete echocardiogram 17.8±10.5 months (mid-term follow-up) and 8.8±0.9 years (long-term follow-up) after the procedure. RESULTS were compared with the echocardiogram carried out 2.1±3.4 days after the procedure (short-term follow-up).
  
  
  RESULTS
  The minimal distance between the left disk and the mitral valve increased: 1.4±2.0 mm at short-term and 5.1±2.3 mm at long-term follow-up (p<0.05), leading to less contact between the disk and the anterior leaflet and less mitral regurgitation (10 at short-term, 4 at long-term follow-up, p<0.05). The number of devices straddling the aorta decreased from 17 to 12 at long-term follow-up (p<0.05). There was protrusion of disk in the venous structure in seven patients on the first echocardiogram, which disappeared at long-term follow-up.
  
  
  CONCLUSIONS
  Although frequently in close contact with the aortic root, mitral valve, or venous returns, large devices tend to centre and move away from the surrounding structures, with decreased risk for long-term distortion.
authors.affiliation: Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montreal,Quebec,Canada.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Raboisson
authors.affiliation: Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montreal,Quebec,Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hugues
authors.affiliation: Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montreal,Quebec,Canada.
authors.forename: Nagib
authors.initials: N
authors.lastname: Dahdah
authors.affiliation: Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montreal,Quebec,Canada.
authors.forename: Myriam
authors.initials: M
authors.lastname: Brassard
authors.affiliation: Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montreal,Quebec,Canada.
authors.forename: Chantale
authors.initials: C
authors.lastname: Lapierre
authors.affiliation: Department of Paediatrics,Division of Paediatric Cardiology,Sainte-Justine University Hospital Center,Montreal,Quebec,Canada.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Miró
mesh_terms: D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055989:Septal Occluder Device / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: atrial septal defect long-term follow-up