Transcatheter Device Closure of Atrial Septal Defects in Small Children: Sound Judgment is Key!

Justino, Henri

doi:10.1016/s2214-1235(15)30115-0

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…Earlier studies have advised against closing the ASD in children when the size of the defect is 1.5–2 times the weight of defect in kgs [ 5 , 30 ]. However, with advance in transcatheter interventions defects more than the 300% the size of the body weight have been closed effectively and safely [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In one patient the defect was large (Defect/Weight ratio 2.1), while in two patients the failure to deliver the device in stable position was due to deficiency of IVC and posterior rim with associated aneurysmal inter atrial septum. Although device embolization is reported more often while closing large defects, it is the deficient margins associated with these large defects or under sizing of the device in terms of its relation to the largest diameter which is usually the reason for it [ 5 , 28 , 30 ]. In our centre the practice is to send for surgical closure if 2 or more of the inferior, superior or atrioventricular valve rims are deficient or absent.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and procedural characteristics of successful transcatheter device closure of ostium secundum atrial septal defect in symptomatic children weighing less than 15 Kg: A retrospective study spanning one decade from South India

Joseph,

Riyaz,

Krupa

et al. 2024

Journal of the Saudi Heart Association

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Objectives This retrospective study sought to determine the feasibility of transcatheter atrial septal defect device closure in patients less than 15 kg, as well as to assess complication rates and the reasons for unsuccessful device closure. Background In general, the risks associated with transcatheter atrial septal defect device closure are believed and reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend atrial defect closure in device closure in children <15 kg, due to limited data available for feasibility and safety of device closure in this group of patients. Methods Retrospective review of all patients who underwent elective transcatheter closure of ostium secundum atrial septal defect between September 2013 to February 2022. We excluded all children above 15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated. Results We identified 81 patients meeting criteria with a median procedural age of 3 years (1 year–8 years), and median weight of 12 kg (4–15 kg). Successful device closure was achieved in 95.1% (77/81) and in 4.9% (4/81), the procedure was aborted. There was 1 major (1.2%) and 1 minor (1.2%) complication, total complication rate (2.4%). 100% of the referrals had right heart enlargement and exertional dyspnoea, 18.5% had recurrent lower respiratory tract infection and 9.9% had failure to thrive. Rate of resolution of residual shunt was 95.1%. at post-procedure day 1 and 98.8% at post-procedure 3 and 6 months respectively. Conclusions Percutaneous atrial septal defect closure can be done effectively and safely in symptomatic children weighing less than 15 kg in experienced centres. However, deferral for closure until the historically established timeline of around 4–5 years of age should be strongly considered in asymptomatic children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical and procedural characteristics of successful transcatheter device closure of ostium secundum atrial septal defect in symptomatic children weighing less than 15 Kg: A retrospective study spanning one decade from South India

Joseph,

Riyaz,

Krupa

et al. 2024

Journal of the Saudi Heart Association

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“…[ 1 4 7 ] Indications for earlier closure of OS ASD in small children have been evaluated in the past and include RV volume overload with worsening right heart enlargement, recurrent LRTI, poor growth, and failure to thrive. [ 3 15 16 17 ] Earlier studies have advised against closing the ASD in children when the size of the defect is 1.5–2 times the weight of the defect in kg,[ 1 18 ] and the current guidelines do not recommend transcatheter closure of OS ASD’s more than 20 mm due to increased risk of complications. [ 8 ] In small children with large ASD, the rims are usually deficient and the left atrial (LA) size is usually small resulting in its inability to accommodate the opened up LA disc, especially when the device required is large, thus resulting in the malalignment of the LA disk with the plane of the interatrial septum causing prolapse of the device across the defect and thus hindering the correct apposition of the device across the defect.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study

Naseem,

Riyaz,

Joseph

et al. 2023

Annals of Pediatric Cardiology

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Background: In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure. Methods: We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up. Results: We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4–7) years and median (IQR) weight of 14 (12–18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%– I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt. Conclusion: In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.

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Transcatheter closure of atrial septal defect in symptomatic children weighing ≤10 kg: Addressing unanswered issues from a decade of experience

2020

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Transcatheter Device Closure of Atrial Septal Defects in Small Children: Sound Judgment is Key!

Cited by 3 publications

References 6 publications

Clinical and procedural characteristics of successful transcatheter device closure of ostium secundum atrial septal defect in symptomatic children weighing less than 15 Kg: A retrospective study spanning one decade from South India

Clinical and procedural characteristics of successful transcatheter device closure of ostium secundum atrial septal defect in symptomatic children weighing less than 15 Kg: A retrospective study spanning one decade from South India

Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study

Transcatheter closure of atrial septal defect in symptomatic children weighing ≤10 kg: Addressing unanswered issues from a decade of experience

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