Thorac Cardiovasc Surg 2013; 61 - P21
DOI: 10.1055/s-0033-1354510

Indications, Feasibility, and Outcome of Interventional Closure of Secundum-Type Atrial Septal Defect in Children with a Bodyweight Less Than 10 kg

W Knirsch 1, D Quandt 1, O Kretschmar 1
  • 1Pediatric Cardiology, University Children's Hospital Zurich, Switzerland

Aim: This study evaluated indications, feasibility, periprocedural complications, and outcome of interventional ASD closures in small children.

Methods: Retrospective analysis (2005 – 2012) of ASD closures in children less than 10 kg bodyweight.

Results: In 25 children (13 male) 24 successful interventional secundum ASD device closures were performed at a median age of 1.2 years (0.2 – 2.8) and a bodyweight of median 7.5 kg (4.6 – 9.9). RV volume overload was present on echocardiography in 24 patients, resulting in an Qp/Qs of mean 1.7 (± 1). Clinically, nine (36%) patients presented with failure to thrive and eight (32%) were past preterm infants with bronchopulmonary dysplasia (BPD). In 12 patients a genetic syndrome (Trisomie 21 in nine patients, 36%) was present. In more than two-third of the patients (n= 18, 72%) pulmonary hypertension was suspected on echocardiography. Hemodynamic evaluation revealed baseline PVR of mean 3.8 WU (± 6.7) and mean PAP 25 mm Hg (± 10). ASD size was mean 8.1 mm (± 2.7) with a ratio of bodyweight/defect size of median 0.87. Mean femoral sheath size used was 7 Fr (± 1.5) and ASD closure devices of 10 mm (± 3 mm), procedure time 84 minutes (± 34), fluoroscopy time 13 minutes (± 7). Complications were prolonged femoral bleeding (n= 1) and femoral venous thrombosis (n= 1). Median follow-up was 0.5 years (0.1 – 6) showing complete closure of ASD with no residual shunt in all 24 patients. All patients showed regression of pulmonary hypertension measured by echocardiography, one patient still being treated with sildenafil.

Conclusions: Interventional ASD closure in small children can be performed safely showing a favorable outcome with a slight device oversizing in defect sizes up to 8 mm and a ratio of bodyweight to defect size of 0.87. Indications for early closure are BPD, failure to thrive or suspected pulmonary hypertension on echocardiography.