Characteristics of secundum atrial septal defects not percutaneously closed

Abstract

Objectives 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. Material and methods All children assessed as unsuitable for transcatheter device closure were reviewed. Data collected included: demographics, defect morphology by echocardiogrphy 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). Conclusion 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. © 2014 Wiley Periodicals, Inc.

Early Surgical Closure of Atrial Septal Defect Improves Clinical Status of Symptomatic Young Children with Underlying Pulmonary Abnormalities

“…Percutaneous ASD device closure has become a standard option for asymptomatic older children and adults with secundum ASD [11]. However, its indication in infants and small children may be limited because of underlying ASD anatomy (defect too large, sinus venosus type or primum type ASD, deficient rim, multiple defects, and aneurysmal septum), small left atrium, and small size of an access vessel [12][13][14]. Surgical ASD closure is frequently indicated for those who are not amenable to the device closure and those who are clinically deteriorating despite maximum medical support, especially in infants and young children with known comorbidity.…”

Predictors of Procedure Time Prolongation During Percutaneous Transcatheter Closure of Atrial Septal Defect

“…It has been reported that patient weight can be used as a guide for device size selection. The criteria proposed that device diameter (in mm) to weight (in kg) ratio should be less < 1.5 [18]. In the current study, multivariate analysis showed that the device waist diameter in relation to the height of the patients seems to be statistically more important than its relation to weight.…”

Percutaneous closure of atrial septal defect: a consensus document of the joint group of experts from the Association of Cardiovascular Interventions and the Grown-Up Congenital Heart Disease Section of the Polish Cardiac Society

“…A deficient rim is defined as less than 5 mm. 64 The deficient retroaortic rim is present in 36% to 57% of patients with secundum ASD. 65 It was shown that percutaneous closure of ASD with the absent or deficient retroaortic rim is the cause of an increased risk of erosion, but most leading centers treat these patients percutaneously.…”