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[Nonsurgical occlusion of an atrial septal defect in childhood: initial Swiss experiences]
Insights
Catheter closure of atrial septal defects (ASD) in children is safe and effective. This minimally invasive technique offers a successful alternative to surgery, with minimal complications and good long-term device stability.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Atrial septal defects (ASD) are common congenital heart conditions in children.
- Surgical closure has been the traditional treatment for ASD.
- Minimally invasive catheter-based closure offers a potential alternative.
Purpose of the Study:
- To present the initial experience with catheter closure of ASD in pediatric patients.
- To evaluate the safety and efficacy of transcatheter ASD closure.
- To assess device performance and patient outcomes.
Main Methods:
- Retrospective analysis of 14 pediatric patients undergoing catheter closure of ASD.
- Utilized various occlusion devices, with a shift towards the Amplatzer occluder.
- Follow-up included echocardiography to assess device position and residual shunting.
Main Results:
- Successful closure achieved in 12 out of 14 children (86%).
- Mean follow-up of 17 months showed only one child with a trivial residual shunt.
- No thrombotic complications or significant device-related issues were reported.
Conclusions:
- Catheter closure of ASD in children is a safe and efficient alternative to surgical treatment.
- The Amplatzer occluder demonstrated good performance in this cohort.
- Transcatheter closure is a viable option for pediatric ASD management.
Abstract:
The initial experience with catheter closure of an atrial septal defect (ASD) in children, performed at two Swiss centers is presented. The ASD closures were performed according to international multicenter study protocols. 14 children, aged 3.9-17.5 years underwent closure by catheter. The defect size varied between 12 and 22 mm (balloon sized), the ratio between pulmonary and systemic blood flow showed a mean of 2.2 (1.5-3.5). Catheter closure was done using three different occlusion devices. More recently only the Amplatzer occluder was used at both institutions. In 12 children (86%) defect closure was successful and after a follow-up of 3-32 months (mean 17) only one child had a trivial residual interatrial shunt. In all children, echocardiographic follow-up showed an unchanged and correct device position on both sides of the atrial septum. In two children, a floppy aortic segment of the atrial septal rim led to instable device position: both children underwent surgical defect closure later. The children with successful device closure showed no complications during the catheterization or during follow-up. There were no thrombotic complications on the surfaces of the devices. Catheter closure of an ASD during childhood is a safe and efficient alternative to standard surgical treatment.