title: Characteristics of secundum atrial septal defects not percutaneously closed.
abstract: OBJECTIVE
  We sought to review our single center experience with secundum atrial septal defect (ASD) device closure, evaluating the incidence and morphological characteristics where percutaneous closure was thought inappropriate.
  
  
  METHODS
  All children assessed as unsuitable for transcatheter device closure were reviewed. Data collected included: demographics, defect morphology by echocardiography or at cardiac catheterization and defect size focusing on the reasons for procedural deferral.
  
  
  RESULTS
  Between January 2002 and December 2010, 639 children underwent closure of an isolated secundum ASD: 82 children (13%) where referred directly to surgery, 43 (6%) were thought unsuitable for device closure at the time of catheterization and underwent subsequent surgery and the remaining 514 (81%) underwent successful device closure including 2 on a second attempt. The reasons for pursuing a surgical closure (n = 124, mean age = 5.7 years; range: 0.6-17.4 years; defect diameter/body weight = 1.39) included: the need for a device thought too large for implantation versus the child's size (n = 51), defects with deficient rim(s) (n = 48), multiple defects (n = 7), defects sized >36 mm (n = 2), malposition (n = 2), ECG changes (n = 3), aneurysmal IAS (n = 2), sinus venosus (n = 2), or others (n = 7).
  
  
  CONCLUSIONS
  The reasons for deferring transcatheter device closure of a secundum ASD are diverse, not only isolated rim deficiencies but the requirements of large implants, malposition, arrhythmias, and lack of hemodynamic need are influential components in clinical decision making.
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohno
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chaturvedi
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.forename: Lee
authors.initials: L
authors.lastname: Benson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001835:Body Weight; D006328:Cardiac Catheterization / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D004452:Echocardiography; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario; D018579:Patient Selection; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: congenital heart disease; interventional cardiology; pediatric cardiac catheterization