Pediatric Cardiology

, Volume 38, Issue 7, pp 1410–1414 | Cite as

The Effect on Somatic Growth of Surgical and Catheter Treatment of Secundum Atrial Septal Defects

  • Meghan M. Chlebowski
  • Hongying Dai
  • Stephen F. Kaine
Original Article


Historical studies suggest an association between atrial septal defect (ASD) and impaired growth with inconsistent improvement following closure. Limited data exist regarding the impact on growth in the era of transcatheter therapy. To evaluate the effect of closure on growth, we conducted a retrospective review of patients undergoing surgical or transcatheter closure during two time periods. Four hundred patients with isolated secundum ASD were divided into three cohorts: early surgical, contemporary surgical, and transcatheter. Data collected included demographics; height, weight, and body mass index (BMI) percentiles; catheterization hemodynamics; and co-morbidities. For all cohorts, there was no significant change in height or weight percentiles during two years after ASD closure. Age at repair was later for contemporary surgical and transcatheter cohorts (p < 0.0001). In the transcatheter cohort, mean Qp:Qs was 1.65 ± 0.54, but there was no correlation between greater Qp:Qs and decreased somatic growth. Subgroup analysis for patients with any initial growth percentile <5th percentile demonstrated a significant change in weight and BMI percentiles in the first two years after closure (p < 0.0004). The advent of transcatheter therapy shifted institutional practice to later age at repair for both surgical and transcatheter closure. There was no significant change in weight and height percentiles during two years after closure. Only patients with initial weight and BMI <5th percentile had improved growth after treatment. Concern for impaired growth should not generally be an indication for early ASD repair. However, early repair may be indicated in children with existing significant growth failure.


Atrial septal defect Congenital heart disease Intervention Growth Children 



Atrial septal defect(s)


Body mass index



The authors acknowledge Christina Robinson, RN, Wendy Davis, RN, Jessica Nachtsheim, RN, Pam Barham, RN, Mark Woolley, MD, and Richard Stroup for their contributions to this project and Abhay Divekar, MD, for careful review of this manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For retrospective studies, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Meghan M. Chlebowski
    • 1
    • 3
  • Hongying Dai
    • 2
  • Stephen F. Kaine
    • 1
    • 3
  1. 1.Division of CardiologyChildren’s Mercy HospitalKansas CityUSA
  2. 2.Division of BiostatisticsChildren’s MercyKansas CityUSA
  3. 3.Department of PediatricsUniversity of Missouri-Kansas City School of MedicineKansas CityUSA

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