Transcatheter Closure of Secundum Atrial

Objective: To assess safety and efficacy of transcatheter atrial septal defect (ASD) closure in small children. Background: Percutaneous closure of ASD is a well accepted alternative to surgery. Reported experience in small children remains, however, scarce. Methods: Fifty-two children underwent percutaneous ASD closure at a weight ≤15 kg, in four Belgian tertiary referral paediatric cardiology centers. Indication for treatment, device implantation rate, pro-cedural details, complication rate, residual shunt on echocardiography, and impact of proce-dure on symptoms were retrospectively analyzed. Results: Mean age at procedure was 36 months (7–60), mean weight 13 kg (4.7–15). Associated cardiac lesions were seen in 21 % of the patients and noncardiac in 32.7%. Most patients (69.2%) were symptomatic. Mean ASD size was 12 mm (range 5–20 mm). A device could be inserted in 49 patients (94%). No major complications occurred. Minor complications occurred in 8 patients (15.4%) including device embolization in 2, successfully treated with transcatheter retrieval and second device inser-tion. Mean follow-up reached 27 months (0.03–61.2). Residual shunt was absent, trivial, or small in 93 % (n = 42) at latest follow-up. Clinical improvement was noted in 91.7%of the symp-tomatic patients. Minor complications were more frequent in the presence of large ASDs (>15 mm) but not in smaller babies (<10 kg). Conclusion: Patients ≤15 kg requiring ASD closure form a special populationwith high incidence of associated anomalies andmedical con-ditions. For this particular set of patients, percutaneous closure is a valid alternative. Asymptom-atic ormildly symptomatic children should be treated at a later age. ' 2006Wiley-Liss, Inc. Key words: congenital heart disease; interventional catheterization; transcatheter clo-sure; devic