Abstract
Objective: To assess safety and efficacy of transcatheter atrial septal defect (ASD) closure in small children. Background: Percutaneous closure of ASD is a well accepted alternative to surgery. Reported experience in small children remains, however, scarce. Methods: Fiftyβtwo children underwent percutaneous ASD closure at a weight β€15 kg, in four Belgian tertiary referral paediatric cardiology centers. Indication for treatment, device implantation rate, procedural details, complication rate, residual shunt on echocardiography, and impact of procedure on symptoms were retrospectively analyzed. Results: Mean age at procedure was 36 months (7β60), mean weight 13 kg (4.7β15). Associated cardiac lesions were seen in 21% of the patients and noncardiac in 32.7%. Most patients (69.2%) were symptomatic. Mean ASD size was 12 mm (range 5β20 mm). A device could be inserted in 49 patients (94%). No major complications occurred. Minor complications occurred in 8 patients (15.4%) including device embolization in 2, successfully treated with transcatheter retrieval and second device insertion. Mean followβup reached 27 months (0.03β61.2). Residual shunt was absent, trivial, or small in 93% (n = 42) at latest followβup. Clinical improvement was noted in 91.7% of the symptomatic patients. Minor complications were more frequent in the presence of large ASDs (>15 mm) but not in smaller babies (<10 kg). Conclusion: Patients β€15 kg requiring ASD closure form a special population with high incidence of associated anomalies and medical conditions. For this particular set of patients, percutaneous closure is a valid alternative. Asymptomatic or mildly symptomatic children should be treated at a later age. Β© 2006 WileyβLiss, Inc.