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Updated: Aug 30, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
The gold standard for atrial septal defect closure: current surgical results, with an emphasis on morbidity
R J F Baskett1, E Tancock, D B Ross
1Maritime Heart Centre, Room 2269, 2nd Floor, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
Insights
Surgical closure of atrial septal defects (ASDs) in children shows excellent short-term outcomes with no mortality or residual defects. Long-term device closure durability remains unknown, necessitating continued comparison with surgical repair.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Medical Devices
Background:
- Device closure for atrial septal defects (ASDs) is increasingly common in pediatric patients.
- Comparisons are often drawn to historical surgical series, which reported higher complication rates.
- However, a comprehensive evaluation requires considering reintervention, late failure, and long-term follow-up data for both methods.
Purpose of the Study:
- To evaluate the outcomes of current surgical closure of atrial septal defects in children.
- To compare surgical outcomes with available short-term data on device closure for ASDs.
- To assess the necessity of long-term follow-up and compare durability against the established surgical standard.
Main Methods:
- A retrospective review of 100 consecutive surgical closures of ASDs in pediatric patients.
- Collection of comprehensive clinical and echocardiographic follow-up data for all patients.
- Literature review of short-term outcomes for ASD device closure procedures.
Main Results:
- No mortality or neurological complications were observed in the surgical cohort.
- No residual ASDs were detected post-surgery.
- Complications included 3 cases of postpericardiotomy syndrome and 26 pericardial effusions, with a median hospital stay of 4 days.
Conclusions:
- Current surgical closure of pediatric atrial septal defects demonstrates excellent short-term results.
- The long-term durability and safety of ASD device closure remain undetermined, posing challenges for direct comparison.
- Surgical repair continues to be the gold standard, requiring long-term comparative studies with device interventions.
Abstract:
Device closure of atrial septal defects (ASDs) is rapidly becoming routine in children. Comparisons are often made to older surgical series with higher morbidities. However outcomes including reintervention, late failure, and the need for long-term follow-up must be considered and compared to those of a current surgical series. One hundred consecutive surgical closures of ASDs in children were reviewed. The mean age was 60.5 +/- 6.4 months; 6 patients underwent repair in the first year of life. Full clinical and echocardiographic follow-up was available on all patients. There was no mortality; there were no residual ASDs and no neurological complications. There were 3 cases of postpericardiotomy syndrome and 26 pericardial effusions. Median stay was 4 days; all patients have been discharged from follow-up. A review of the literature on the short-term follow-up of ASD devices revealed a number of problems. Their long-term durability is unknown. As such, it remains an experimental procedure and must be compared over the long-term to the current gold standard, surgical repair.
