Related Experiment Video
Updated: May 20, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Percutaneous atrial septal defect closure in infants and toddlers: predictors of success
Christopher J Petit1, Henri Justino, Ricardo H Pignatelli
1Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA. cp31971@yahoo.com
Insights
Device closure of atrial septal defects (ASD) is feasible in young children. A higher ASD size-to-patient weight ratio predicts successful percutaneous closure, not absolute size or age.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Device closure of atrial septal defects (ASD) is typically for older patients.
- Infants and toddlers (<4 years) are rarely candidates due to size limitations.
Purpose of the Study:
- To evaluate the feasibility and success of percutaneous ASD closure in infants and toddlers.
- To identify predictors of procedural success in this young population.
Main Methods:
- Retrospective review of 61 infants and toddlers undergoing ASD closure procedures between 2002-2012.
- Analysis of pre- and intra-procedural echocardiograms and catheterization reports.
- Multivariate analysis to determine factors associated with procedural success.
Main Results:
- Successful device closure was achieved in 48 of 53 infants and toddlers (79%).
- Larger ASD size and deficient rims were noted in unsuccessful cases.
- An ASD size-to-patient weight ratio <1.2 was independently associated with successful closure (HR 9.5).
Conclusions:
- Percutaneous ASD device occlusion is safe and effective in small children.
- The ASD size-to-patient weight ratio is a key predictor of success, outweighing absolute patient size or age.
- Midterm outcomes for young patients undergoing ASD device closure are excellent.
Abstract:
Device closure of atrial septal defect (ASD) is commonly performed in older children and adults. Infants and toddlers (age <4 years) are seldom referred for ASD closure due to size constraints. However, in many cases device ASD closure can be performed in this population. Between 2002 and 2012, 61 infants and toddlers were taken to the catheterization laboratory at our institution for ASD closure. Precatheterization transthoracic echocardiograms, intracatheterization transesophageal echocardiograms, and catheterization reports were reviewed. Fifty-three infants and toddlers presented for percutaneous ASD occlusion. Forty-eight (79 %) underwent successful closure, and 13 were referred for surgery without device attempt (n = 8) or after unsuccessful device occlusion (n = 4). Median age and weight at time of ASD closure were 2.99 years (range 0.3-3.8) and 11.7 kg (range 3.7-16.5). The device-to-septal length ratio was 0.81 (range 0.44-1.03). The 12 unsuccessful cases occurred in patients with larger defects (ASD diameter 17.5 ± 6.1 vs. 12.1 ± 4.2, p < 0.01). Deficient rims (absent or ≤ 4 mm) were seen in 9 of 12 (75 %) unsuccessful cases and in 19 of 41 (46 %) successful cases (p = 0.12). Multivariate analysis showed that patient size and ASD size were not independently associated with procedural success but that ASD size-to-patient weight ratio <1.2 (hazard ratio 9.5 [range1.7-17]) was associated with successful ASD closure. ASD device occlusion can be safely achieved in small children. An ASD size-to-patient weight ratio >1.2, not absolute patient weight or age, is associated with failure of the percutaneous approach. The midterm outcomes in these young patients are excellent.
