Transcatheter closure of large atrial septal defects (ASDs) in symptomatic children with device/weight ratio ≥1.5.

BACKGROUND

Atrial septal defects (ASDs) can be symptomatic in small children in cases of co-morbidities. Transcatheter closure remains controversial for large defects in small children.

OBJECTIVE

To describe transcatheter closure of ASDs in children with device/weight ratio ≥1.5.

METHODS

We retrospectively studied between January 2000 and January 2016 all cases of percutaneous ASD closure with device/weight ratio ≥1.5 in 6 European centres.

RESULTS

Forty patients were included with female/male ratio of 1.2. Median age and weight were 30.9 months (4.1-102.0) and 11.0 kg respectively (3.8-19.0). Median device size/weight ratio was 1.7 (1.5-2.3). All patients were symptomatic, with pulmonary hypertension in 13 (33%). Procedures were performed under general anesthesia or light sedation (n = 4), with transthoracic (n = 25) or transesophageal echocardiography (n = 15) guidance. Balloon stretched diameter (n = 32) was larger than the echocardiographic diameter (19 versus 15 mm, R = 0.6; p < 0.001). Deficient rims other than the anterior-superior one were found in 33% of cases. Device implantation was successful in 39 patients (97.5%). Minor complications occurred in 10% of cases, whereas severe complications rate was 5%: Complete atrioventricular block in one patient that resolved after surgical extraction of the device and thrombosis in the inferior vena cava in one patient. During a median follow-up of 52 months, there was no residual shunt. No case of erosion or embolization was reported and pulmonary hypertension resolved in all patients.

CONCLUSION

Percutaneous closure of large ASD in small and symptomatic children is feasible and allows clinical improvement with acceptable rate of complications in high risk population.