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Updated: Dec 31, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age
Yangyang Han1, Xiquan Zhang2, Fengwei Zhang1
1Department of Cardiovascular Surgery, Linyi People's Hospital, Affiliated Hospital of Shandong University, Jiefang Street No. 27, Linyi, 276000, Shandong Province, China.
Insights
Transcatheter and intraoperative device closure are safe and effective for treating atrial septal defects (ASDs) in infants under three. Transcatheter closure is preferred for suitable candidates due to shorter procedure times and hospital stays.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Secundum atrial septal defect (ASD) treatment in young infants using device closure is debated due to limited data.
- Transcatheter and intraoperative device closures are established treatments for ASDs.
Purpose of the Study:
- To compare clinical data and follow-up results of percutaneous and intraoperative device closure for ASDs in infants under 3 years.
- To evaluate the feasibility, safety, and efficacy of both ASD treatment methods in this pediatric population.
Main Methods:
- Retrospective analysis of 186 children under 3 years with significant secundum ASD from September 2010 to September 2018.
- Patients were divided into two groups: Group A (88 patients, transcatheter device closure) and Group B (98 patients, intraoperative device closure).
Main Results:
- Successful closure rates were high in both groups (97.7% vs 98.0%).
- Transcatheter closure (Group A) showed significantly shorter procedure and hospital stay durations compared to intraoperative closure (Group B).
- No deaths or major complications were reported; all infants showed symptom resolution or improvement, with no residual shunts at 6-month follow-up.
Conclusions:
- Both transcatheter and intraoperative device closure are feasible, effective, and safe for treating ASDs in infants under 3.
- Transcatheter closure is recommended for appropriate candidates due to cosmetic benefits and shorter recovery times.
- Intraoperative closure serves as a viable alternative for complex ASDs, younger infants, or those with low body weight.
Background:
Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age.
Methods:
From September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively.
Result:
The mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up.
Conclusion:
Transcatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.
