Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center
Jahangir Ahmed Naseem1, Mirza Shohiab Ur Riyaz1, Shobhit Priyanshu Joseph1
1Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India.
Insights
Transcatheter atrial septal defect (ASD) device closure is safe and effective for small children with large defects, showing a 97.5% success rate and low complication rates. This procedure offers a predictable and beneficial treatment option for this patient group.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Transcatheter atrial septal defect (ASD) device closure evidence primarily comes from adult and older child trials.
- Current guidelines limit ASD device closure for defects >20 mm due to insufficient data in small children.
- This study addresses the lack of data for transcatheter ASD device closure in small children with large defects.
Purpose of the Study:
- To evaluate the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects.
- To assess complication rates associated with this procedure in this specific pediatric population.
- To identify reasons for unsuccessful device closure in children weighing <20 kg requiring devices ≥20 mm.
Main Methods:
- Retrospective review of patients undergoing transcatheter closure of ostium secundum ASD (Sept 2013 - Feb 2022).
- Inclusion criteria: children <20 kg requiring a device ≥20 mm.
- Evaluation of major/minor complications, referral indications, and echocardiogram data at baseline, day 1, and 1-year follow-up.
Main Results:
- 40 patients (median age 5 years, weight 14 kg) were included.
- Successful device closure achieved in 97.5% (39/40 patients) with a low overall complication rate of 2.5%.
- One major complication occurred; 1-year follow-up showed stable device position, no residual shunt, and symptom improvement.
Conclusions:
- Percutaneous ASD closure of large defects in symptomatic small children is effective and safe in experienced centers.
- The procedure demonstrates a high degree of predictability and a low complication rate.
- Transcatheter closure is a viable and recommended option for this challenging pediatric group.
Background:
In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure.
Methods:
We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up.
Results:
We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4-7) years and median (IQR) weight of 14 (12-18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%- I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt.
Conclusion:
In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.
