Interventional Closure of Secundum Type Atrial Septal Defects in Infants Less Than 10 Kilograms: Indications and Procedural Outcome.
OBJECTIVE
This study set out to assess indications, feasibility, complications, and clinical outcome of percutaneous transcatheter device closure of atrial septal defects (ASDs) in infants with a bodyweight below 10 kg.


RESULTS
Retrospective single center chart and echocardiography review study from 8/2005-12/2013. Twenty-eight children with ASD (13 female) with a median age of 1.15 years (0.2-2.8) and a median weight of 7.2 kg (4.5-9.9) were analyzed. Indications for early ASD closure were failure to thrive (n = 15, 54%), bronchopulmonary dysplasia (BPD) with supplemental oxygen dependency (n = 7, 25%), and genetic syndromes with suspected pulmonary hypertension (n = 12, 43%). Device implantation was successful in all patients without any periprocedural mortality or major complication. Clinical outcome after a median follow-up period of 2.1 years (0.25-7.3) revealed no residual shunt and a significant decrease of right ventricular volume load. Patients with pulmonary hypertension experienced a significant reduction of pulmonary artery/RV pressure. Patients also showed decreased supplemental oxygen dependency and less cardiac medications, but no significant "catch-up growth" in those with failure to thrive.


CONCLUSIONS
Interventional ASD closure in children weighing less than 10 kg can be performed without any additional major risks and shows a favorable outcome, especially in selected patients with significant non cardiac co-morbidities.
Paediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstrasse, Zurich, Switzerland.
Yves
Y
Wyss
Paediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstrasse, Zurich, Switzerland.|Children's Research Centre, University Children's Hospital Zurich, Switzerland.
Daniel
D
Quandt
Paediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstrasse, Zurich, Switzerland.|Children's Research Centre, University Children's Hospital Zurich, Switzerland.
Roland
R
Weber
Paediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstrasse, Zurich, Switzerland.|Children's Research Centre, University Children's Hospital Zurich, Switzerland.
Brian
B
Stiasny
Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
Benedikt
B
Weber
Paediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstrasse, Zurich, Switzerland.|Children's Research Centre, University Children's Hospital Zurich, Switzerland.
Walter
W
Knirsch
Paediatric Heart Centre, University Children's Hospital Zurich, Steinwiesstrasse, Zurich, Switzerland.|Children's Research Centre, University Children's Hospital Zurich, Switzerland.
Oliver
O
Kretschmar
D001835:Body Weight; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal / Q000379:methods; D005183:Failure to Thrive / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D020379:Risk Adjustment; D055989:Septal Occluder Device; D013557:Switzerland; D016896:Treatment Outcome