Skip to main content
SpringerLink
Log in

Percutaneous Atrial Septal Defect Closure in Infants and Toddlers: Predictors of Success

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Device closure of atrial septal defect (ASD) is commonly performed in older children and adults. Infants and toddlers (age <4 years) are seldom referred for ASD closure due to size constraints. However, in many cases device ASD closure can be performed in this population. Between 2002 and 2012, 61 infants and toddlers were taken to the catheterization laboratory at our institution for ASD closure. Precatheterization transthoracic echocardiograms, intracatheterization transesophageal echocardiograms, and catheterization reports were reviewed. Fifty-three infants and toddlers presented for percutaneous ASD occlusion. Forty-eight (79 %) underwent successful closure, and 13 were referred for surgery without device attempt (n = 8) or after unsuccessful device occlusion (n = 4). Median age and weight at time of ASD closure were 2.99 years (range 0.3–3.8) and 11.7 kg (range 3.7–16.5). The device-to-septal length ratio was 0.81 (range 0.44–1.03). The 12 unsuccessful cases occurred in patients with larger defects (ASD diameter 17.5 ± 6.1 vs. 12.1 ± 4.2, p < 0.01). Deficient rims (absent or ≤4 mm) were seen in 9 of 12 (75 %) unsuccessful cases and in 19 of 41 (46 %) successful cases (p = 0.12). Multivariate analysis showed that patient size and ASD size were not independently associated with procedural success but that ASD size-to-patient weight ratio <1.2 (hazard ratio 9.5 [range1.7–17]) was associated with successful ASD closure. ASD device occlusion can be safely achieved in small children. An ASD size-to-patient weight ratio >1.2, not absolute patient weight or age, is associated with failure of the percutaneous approach. The midterm outcomes in these young patients are excellent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Allen H, Gutgesell H, Clark E, Driscoll D (2003) Moss and Adams’ heart disease in infants, children, and adolescents, 6th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  2. Bull C, Deanfield J, de Leval M, Stark J, Taylor JF, Macartney FJ (1981) Correction of isolated secundum atrial septal defect in infancy. Arch Dis Child 56(10):784–786

    Article  PubMed  CAS  Google Scholar 

  3. Butera G, De Rosa G, Chessa M, Rosti L, Negura DG, Luciane P et al (2003) Transcatheter closure of atrial septal defect in young children: results and follow-up. J Am Coll Cardiol 42(2):241–245

    Article  PubMed  Google Scholar 

  4. Campbell M (1970) Natural history of atrial septal defect. Br Heart J 32(6):820–826

    Article  PubMed  CAS  Google Scholar 

  5. Cardenas L, Panzer J, Boshoff D, Malekzadeh-Milani S, Ovaert C (2007) Transcatheter closure of secundum atrial defect in small children. Catheter Cardiovasc Interv 69(3):44–452

    Article  Google Scholar 

  6. Chan KC, Godman MJ, Walsh K, Wilson N, Redington A, Gibbs JL (1999) Transcatheter closure of atrial septal defect and interatrial communications with a new self expanding nitinol double disc device (Amplatzer septal occluder): multicentre UK experience. Heart 82(3):300–306

    PubMed  CAS  Google Scholar 

  7. Diab KA, Cao QL, Bacha EA, Hijazi ZM (2007) Device closure of atrial septal defects with the Amplatzer septal occluder: safety and outcome in infants. J Thorac Cardiovasc Surg 134(4):960–966

    Article  PubMed  Google Scholar 

  8. Ding J, Ma G, Huang Y, Wang C, Zhang X, Zhu J et al (2009) Right ventricular remodeling after transcatheter closure of atrial septal defect. Echocardiography 26(10):1146–1152

    Article  PubMed  Google Scholar 

  9. Eerola A, Pihkala JI, Boldt T, Mattila IP, Poutanen T, Jokinen E (2007) Hemodynamic improvement is faster after percutaneous ASD closure than after surgery. Catheter Cardiovasc Interv 69(3):432–441 discussion 442

    Article  PubMed  Google Scholar 

  10. Fischer G, Smevik B, Kramer HH, Bjornstad PG (2009) Catheter-based closure of atrial septal defects in the oval fossa with the Amplatzer device in patients in their first or second year of life. Catheter Cardiovasc Interv 73(7):949–955

    Article  PubMed  CAS  Google Scholar 

  11. Hunt CE, Lucas RV Jr (1973) Symptomatic atrial septal defect in infancy. Circulation 47(5):1042–1048

    Article  PubMed  CAS  Google Scholar 

  12. Karamlou T, Diggs BS, Ungerleider RM, McCrindle BW, Welke KF (2008) The rush to atrial septal defect closure: is the introduction of percutaneous closure driving utilization? Ann Thorac Surg 86(5):1584–1590 discussion 1590–1581

    Article  PubMed  Google Scholar 

  13. King TD, Thompson SL, Steiner C, Mills NL (1976) Secundum atrial septal defect, Nonoperative closure during cardiac catheterization. AMA 235(23):2506–2509

    Article  CAS  Google Scholar 

  14. Lammers A, Hager A, Eicken A, Lange R, Hauser M, Hess J (2005) Need for closure of secundum atrial septal defect in infancy. J Thorac Cardiovasc Surg 129(6):1353–1357

    Article  PubMed  Google Scholar 

  15. Lee YS, Jeng MJ, Tsao PC, Yang CF, Soong WJ, Hwang B et al (2009) Pulmonary function changes in children after transcatheter closure of atrial septal defect. Pediatr Pulmonol 44(10):1025–1032

    Article  PubMed  Google Scholar 

  16. Lim DS, Matherne GP (2007) Percutaneous device closure of atrial septal defect in a premature infant with rapid improvement in pulmonary status. Pediatrics 119(2):398–400

    Article  PubMed  Google Scholar 

  17. Manning PB, Mayer JE Jr, Sanders SP, Coleman EA, Jonas RA, Keane JF et al (1994) Unique features and prognosis of primum ASD presenting in the first year of life. Circulation 90(5 Pt 2):II30–II35

    PubMed  CAS  Google Scholar 

  18. Mills NL, King TD (2003) Late follow-up of nonoperative closure of secundum atrial septal defects using the King-Mills double-umbrella device. Am J Cardiol 92(3):353–355

    Article  PubMed  Google Scholar 

  19. Petit C, Justino H, Fraser C (2012) Percutaneous closure of an atrial septal defect in an infant with Shone’s syndrome. Catheter Cardiovasc Interv 80:880–883

    Google Scholar 

  20. Rashkind WJ (1983) Transcatheter treatment of congenital heart disease. Circulation 67(4):711–716

    Article  PubMed  CAS  Google Scholar 

  21. Rastogi N, Smeeton NC, Qureshi SA (2009) Factors related to successful transcatheter closure of atrial septal defects using the Amplatzer septal occluder. Pediatr Cardiol 30(7):888–892

    Article  PubMed  Google Scholar 

  22. Rossi RI, Cardoso Cde O, Machado PR, Francois LG, Horowitz ES, Sarmento-Leite R (2008) Transcatheter closure of atrial septal defect with Amplatzer device in children aged less than 10 years old: immediate and late follow-up. Catheter Cardiovasc Interv 71(2):231–236

    Article  PubMed  Google Scholar 

  23. Turkay S, Abdullah E, Celal A, Cenap Z, Nurdan E, Fadli D et al (2010) Multiple transcatheter interventions in the same session in congenital cardiopathies. J Cardiovasc Dis Res 1(4):181–190

    Article  PubMed  Google Scholar 

  24. Wood AM, Holzer RJ, Texter KM, Hill SL, Gest AL, Welty SE et al (2011) Transcatheter elimination of left-to-right shunts in infants with bronchopulmonary dysplasia is feasible and safe. Congenit Heart Dis 6(4):330–337

    Article  PubMed  Google Scholar 

  25. Zaqout M, De Baets F, Schelstraete P, Suys B, Panzer J, Francois K et al (2010) Pulmonary function in children after surgical and percutaneous closure of atrial septal defect. Pediatr Cardiol 31(8):1171–1175

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, 77030, USA

    Christopher J. Petit, Henri Justino, Ricardo H. Pignatelli, Matthew A. Crystal, William A. Payne & Frank F. Ing

Authors
  1. Christopher J. Petit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henri Justino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricardo H. Pignatelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew A. Crystal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William A. Payne
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank F. Ing
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher J. Petit.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Petit, C.J., Justino, H., Pignatelli, R.H. et al. Percutaneous Atrial Septal Defect Closure in Infants and Toddlers: Predictors of Success. Pediatr Cardiol 34, 220–225 (2013). https://doi.org/10.1007/s00246-012-0413-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-012-0413-6

Keywords

Search

Navigation