Device closure of large atrial septal defects requiring devices ≥20 mm in small children weighing <20 kg

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Abstract
Objective: To report our experience of transcatheter closure of large atrial septal defects (ASDs) in small children. Background: Although transcatheter closure of small and medium sized ASDs is well established, large ASDs are still mostly treated surgically. There is little data available on the transcatheter closure of large ASDs in children. Methods: This was a retrospective study comprising 32 children weighing less than 20 kg, diagnosed with isolated large ASDs (requiring devices ≥20 mm in diameter). All of them underwent transcatheter closure using the amplatzer septal occluder (ASO). They were assessed by clinical examination by ECG and echocardiography before the procedure and also 1 day, 6 weeks, 6 months, and yearly thereafter. Results: Age and weight of the patients were 4.5 ± 1.8 years and 14.6 ± 3.5 kg, respectively. The mean ASD diameter was 16.6 ± 2.1 mm and balloon-stretched diameter was 22.7 ± 2.6 mm. The mean Qp/Qs was 2.7 ± 0.4. The median device size used was 24 mm (range 20–32 mm). The device was successfully placed in 31 patients. One patient had malpositioning of the device requiring surgical removal. Another patient developed transient atrioventricular block which recovered within 48 hr. During a mean follow-up of 26.8 ± 21.8 months, no major complication such as cerebrovascular accident, cardiac perforation, systemic thromboembolism, atrioventricular valve regurgitation, obstruction to systemic or pulmonary veins or rhythm disturbances. Conclusions: Transcatheter closure of large ASDs in small children using the ASO is feasible and is not associated with a greater risk of significant complications.

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