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J Am Coll Cardiol, 2003; 42:241-245, doi:10.1016/S0735-1097(03)00589-8 © 2003 by the American College of Cardiology Foundation |
* Pediatric Cardiology Department, Istituto Policlinico San Donato, San Donato Milanese, Italy
Manuscript received December 18, 2002; revised manuscript received March 6, 2003, accepted April 3, 2003.
* Reprint requests and correspondence: Dr. Gianfranco Butera, Pediatric Cardiology, Istituto Policlinico San Donato, Via Morandi, 30, 20097 San Donato Milanese, Milanese, Italy.
gianfra.but{at}lycos.com
OBJECTIVES: This study sought to analyze the safety, efficacy, and follow-up results of percutaneous closure of secundum atrial septal defect (ASD) in young children.
BACKGROUND: Results of ASD transcatheter closure in adults are widely reported but there are no large published series concerning young children.
METHODS: Between December 1996 and February 2002, 48 of 553 patients percutaneously treated at our institution were children age 
5 years. Indications for closure were: elective closure in 32 patients; frequent respiratory infections in 8; failure to thrive in 2; liver transplantation in 5; and a fenestrated Fontan in 1. The procedure was carried out under general anesthesia with fluoroscopy and transesophageal control. Two different devices were used: 1) the CardioSEAL/StarFLEX (CS/SF) and 2) the Amplatzer septal occluder (ASO). Basal physical examinations and echocardiograms were performed prior to the procedure and at follow-ups (1, 6, and 12 months, and yearly thereafter).
RESULTS: The mean age at closure was 3.6 ± 1.3 years. A CS/SF was used in 10 subjects; an ASO was used in 38 patients. No deaths or immediate major complications occurred. The total occlusion rate was 87% at procedure, rising to 94% at discharge. The mean follow-up was 18 ± 14 months. No midterm major or minor complications occurred. The occlusion rate rose to 100% at 12 months of follow-up. Symptomatic patients improved significantly.
CONCLUSIONS: In the current era and in experienced hands, ASD closure can be performed safely and successfully, even in very young children.
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