ASD Diameter Indexed to Total Septal Length Outperforms Expert Opinion in Predicting Future Candidacy for...

Area of Science:

• Pediatric Cardiology
• Interventional Cardiology
• Echocardiography

Background:

• Percutaneous device closure is a preferred alternative to surgery for secundum atrial septal defects (ASDs).
• Surgical closure is often performed before age two using a mini-sternotomy approach.
• Device closure is typically performed at older ages, necessitating prediction of candidacy in early childhood.

Purpose of the Study:

• To identify predictors of future percutaneous device closure candidacy in infants with secundum ASDs.
• To evaluate the accuracy of early echocardiographic measurements in predicting later device closure suitability.

Main Methods:

• Retrospective review of 54 secundum ASD closures performed after age three.
• Independent review of "early" (12-24 months) and "pre-intervention" (after 36 months) echocardiograms by blinded echocardiographers and a catheterization team.
• Multivariable analysis to identify predictive echocardiographic parameters.

Main Results:

• Moderate agreement (Cohen's Kappa = 0.56) between early and pre-intervention echocardiograms for device candidacy.
• The ratio of maximum ASD diameter to total septal length (ASD/TSL) between 1-2 years of age strongly predicted device closure candidacy (AUC = 0.92).
• An ASD/TSL ratio < 0.46 demonstrated high sensitivity (89%) and specificity (89%) for predicting future candidacy, outperforming expert consensus.

Conclusions:

• The ASD/TSL ratio measured on early echocardiograms (12-24 months) is a reliable predictor of later percutaneous device closure candidacy for secundum ASDs.
• This measurement can aid in planning interventions and managing pediatric cardiac patients.
• Early identification of device closure suitability can optimize treatment strategies for children with ASDs.