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Updated: May 22, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
A strategy for atrial septal defect closure in small children that eliminates long-term wall erosion risk
Kevin D Hill1, Andrew J Lodge, Daniel Forsha
1Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA. kevin.hill@duke.edu
Insights
This study shows that using the HELEX Septal Occluder (HSO) device or surgery for atrial septal defect (ASD) closure in children under 20 kg is safe and effective. This approach minimizes complications like cardiac wall erosion.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Cardiac wall erosion is a serious risk in atrial septal defect (ASD) device closure.
- The HELEX Septal Occluder (HSO) is a compliant device with no reported erosion but is difficult to deploy in small children.
- A combined approach using HSO when feasible and surgery for larger defects can mitigate erosion risk.
Purpose of the Study:
- To assess the feasibility, efficacy, and safety of a dual approach for atrial septal defect (ASD) closure in children weighing 20 kg or less.
- To evaluate an ASD closure strategy that eliminates the risk of cardiac wall erosion.
Main Methods:
- Retrospective review of ASD closure procedures in children weighing 20 kg or less between January 2006 and January 2011.
- Analysis of HELEX Septal Occluder (HSO) device placement success rates and surgical closure outcomes.
- Comparison of patient demographics, defect characteristics, and adverse events between the two closure methods.
Main Results:
- A total of 60 children underwent ASD closure; 32 with HSO and 28 with surgery.
- HSO placement was successful in 32/34 patients; surgical closure was successful in all 28 patients.
- Surgical patients were younger, smaller, and had larger ASDs. Residual leaks were observed in 44% of HSO patients initially, decreasing to 3.8% at 6-month follow-up. Serious adverse events were infrequent.
Conclusions:
- The HELEX Septal Occluder (HSO) can be safely utilized in the majority of children weighing 20 kg or less for ASD closure.
- This combined approach results in minimal morbidity and favorable short-term outcomes.
- The strategy effectively eliminates cardiac wall erosion risk and may increase surgical referrals by no more than 15%.
Objectives:
To evaluate feasibility, efficacy, and safety of an approach to atrial septal defect (ASD) occlusion in children ≤20 kg that eliminates cardiac wall erosion risk.
Background:
Cardiac wall erosion is a potentially catastrophic complication of ASD device closure. The HELEX Septal Occluder (HSO) is a compliant device with no reports of erosion. The HSO is technically difficult to deploy in smaller children and cannot be used to close larger defects. To eliminate wall erosion risk, we use the HSO when feasible and surgery for larger defects.
Methods:
Retrospective review of ASD procedures performed in children ≤20 kg.
Results:
Between January 2006 and January 2011, 60 children underwent ASD closure. HSO placement was successful in 32 of 34 patients, and surgical closure was successful in all of 28 patients. Surgical patients were younger (35.1 ± 12.6 vs. 47.4 ± 15.3 months, P < 0.01) and smaller (15.3 ± 3.2 vs. 12.6 ± 4.3 kg; P < 0.01) with larger ASDs (15.8 ± 4.5 vs. 9.8 ± 3.0 mm; P < 0.01). No surgical patients demonstrated residual leak. Residual leak was seen in 14 of 32 (44%) HSO patients on postprocedure day #1 and in 1 of 26 (3.8%) with ≥6 months follow-up. Indications for surgery included: deficient inferior/superior rims (n = 17), provider preference (n = 2), and HSO device not feasible (n = 9). Serious adverse events included device embolization with percutaneous retrieval (n = 1) and postpericardiotomy syndrome without intervention (n = 1).
Conclusions:
The HSO can be safely used in most children ≤20 kg. Our approach to ASD closure is associated with minimal morbidity and good short-term results. This approach requires no more than a 15% increase in surgical referrals and eliminates risk of cardiac wall erosion.
