title: New Pediatric Version of Balloon-Assisted Technique for Atrial Septal Defect Closure Using Self-Centering Devices: Relation to Interatrial Septal Thickness.
abstract: OBJECTIVE
  Some difficult atrial septal defect (ASD) cases with deficient rims or large defects may require specific maneuvers to facilitate transcatheter occlusion of these defects with self-centering devices. In our center, we developed a modification of balloon-assisted technique (BAT) for difficult ASDs to assist proper positioning of the device. Our aim was to demonstrate the efficiency of ASD closure with self-centering devices in children and to present the results of the new pediatric version of BAT (PBAT) in young children and its relation to the interatrial septal thickness.
  
  
  RESULTS
  Over 2 years, a total of 65 patients with ASD secundum were referred for closure, from which 50 cases were deemed suitable for transcatheter closure by transthoracic echocardiography during precatheter evaluation. Ten difficult defects required assisted techniques; 6 of these were successfully closed using the PBAT with a small-sized valvuloplasty balloon. The cut-off levels for needing an assistance technique in pediatric patients were age >5 years, ASD >16 mm, and weight >22 kg. The interatrial septal thickness was thinner in young ASD patients.
  
  
  CONCLUSIONS
  The PBAT was needed to optimize device closure in difficult cases, especially in large defects without rim deficiency. This technique is easy to learn and results in quick and simple device closure.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Cairo University, 2 Ali Basha Ibrahim Street, Mounira, 5 Kasr Al Ainy St, Cairo, Egypt. myheartclinic@windowslive.com.
authors.forename: Sonia A
authors.initials: SA
authors.lastname: El Saiedi
authors.forename: Wael A
authors.initials: WA
authors.lastname: Attia
mesh_terms: D000293:Adolescent; D054087:Atrial Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome