title: Growth of the atrial septum after Amplatzer device closure of atrial septal defects in young children.
abstract: BACKGROUND
  Trans-catheter closure of atrial septal defects (ASD) with the Amplatzer Septal Occluder (ASO) device is safe and effective, but concern over erosions has increased. Devices are placed in growing children but septal growth after ASOs is ill-defined. Understanding the device relationship to cardiac structures as a child grows may help us understand erosions.
  
  
  OBJECTIVE
  To define (1) how preprocedural septal measurements change after ASO and (2) the effect of somatic growth on these dimensions.
  
  
  METHODS
  Data were collected retrospectively. Echocardiograms were reviewed and rims measured prior to ASO, immediately after ASO, and at follow-up. Demographic, procedural and device data were collected.
  
  
  RESULTS
  Thirty-three patients were enrolled; mean age 5.2 ± 3.2 years with 4.0 ± 2.2 years follow-up. All septal measurements decreased after ASO. Thirty-one of 33 devices (94%) contacted the aortic root after ASO; all remained in contact at follow-up with only the IVC rim growing significantly over time. Change in BSA predicted an asymmetric septal growth with increases in superior (P = 0.01) and IVC (P = 0.005) rims and no increase in aortic or AVV rims. No episodes of erosion occurred.
  
  
  CONCLUSIONS
  ASDs in young children are not central in the septum, but proximate to the aorta. After ASO, the device remains in close proximity to the aorta. With somatic growth, the septum grows asymmetrically, and device position relative to the aorta is constant. Our study was not powered to detect rare serious adverse events such as erosion, but aortic rims were consistently zero and yet no events occurred.
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Gossett
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Laura
authors.initials: L
authors.lastname: Mansfield
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Acevedo
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Lay
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Karen
authors.initials: K
authors.lastname: Rychlik
authors.affiliation: Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois.
authors.forename: David F
authors.initials: DF
authors.lastname: Wax
mesh_terms: D000367:Age Factors; D001827:Body Height; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D016014:Linear Models; D008297:Male; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D016896:Treatment Outcome
keywords: atrial septal defect; catheterization; erosion; occluder; pediatric; perforation