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Updated: Aug 20, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transcatheter closure of atrial septal defects in children with a hypoplastic right ventricle
Mehnaz Atiq1, Lillian Lai, Kyong-Jin Lee
1Department of Pediatrics, Division of Cardiology, Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Ontario, Canada.
Insights
Device closure of atrial defects is safe and effective for children with hypoplastic right ventricles. This catheter-based strategy improves oxygen saturation and exercise tolerance, aiding staged management of complex congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Device closure of atrial defects in children with hypoplastic right ventricles is not well-documented.
- Complex congenital heart disease requires tailored management strategies.
Purpose of the Study:
- To evaluate the clinical impact and outcomes of staged, catheter-based management of atrial defects in children with hypoplastic right ventricles.
- To assess the safety and efficacy of device closure in this specific pediatric population.
Main Methods:
- Retrospective analysis of 17 children with hypoplastic right ventricles undergoing cardiac catheterization for atrial defect device closure.
- Comparison of clinical and echocardiographic findings before and after the procedure.
- Inclusion of patients with pulmonary atresia, Ebstein's anomaly, and isolated right ventricular hypoplasia.
Main Results:
- Successful device closure of atrial defects was achieved in the study cohort.
- Significant improvement in oxygen saturation (91% to 98%) and exercise tolerance was observed.
- Right ventricular length and Z-score increased post-procedure, with no significant changes in systolic pressures or function.
Conclusions:
- Catheter-based device closure of atrial defects is a well-tolerated, safe, and effective treatment.
- This strategy is beneficial for staged management in children with hypoplastic right ventricles and complex congenital heart disease.
Abstract:
The efficacy and safety of device closure of atrial defects in children with complex congenital heart disease and a hypoplastic right ventricle have not been detailed. The objective of this study was to determine the clinical impact and outcomes of a staged surgical catheter-based management strategy. A retrospective analysis of 17 children with a hypoplastic right ventricle who had undergone cardiac catheterization and attempted device occlusion of an atrial defect was undertaken. Clinical data, anatomical diagnoses, previous surgeries, and interventions were noted. The clinical course and echocardiographic findings were compared before and after defect closure (6 +/- 4 months of follow-up). Nine children had pulmonary atresia with an intact ventricular septum, six had Ebstein's anomaly of the tricuspid valve, and two had isolated right ventricular hypoplasia. The mean age at defect closure was 6.6 +/- 3.4 years. Under general anesthesia, closure of the atrial defect was undertaken after initial temporary test occlusion. The Qp:Qs ratio before closure was 1.1 +/- 0.4. Oxygen saturation improved in all children from 91% +/- 1% to 98% +/- 1% (P < 0.0005). Mean right atrial pressure increased from 9 +/- 3 to 11 +/- 4 mm Hg after closure, but the difference was not statistically significant (P = 0.2). Follow-up revealed an increased right ventricular length (P = 0.009) and Z-score (P = 0.02), although no significant increase in the diameter of the tricuspid valve annulus was observed in children with pulmonary atresia. Right ventricular systolic pressures or systolic function did not change significantly during follow-up (P = 0.5 and 0.29, respectively). Exercise tolerance improved in all children and clinical evidence of right ventricular decompensation was absent. Catheter closure of atrial defects in children with a hypoplastic right ventricle is well tolerated, safe, and effective as a treatment strategy in the staged management.
