Clinical Characteristics and Outcome of Incidental Atrial Septal Openings in Very Low Birth Weight Infants

Lee, Chungho; Lim, Gina; Kim, Won Seop; Han, Heon

doi:10.1159/000356164

Cited by 10 publications

(8 citation statements)

References 41 publications

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“…Recent guidelines recommend transcatheter closure after the age of 2, although common practice suggests a weight over 15 kg [ 10 ]. Symptomatic infants, such as those born prematurely, with failure to thrive or with additional comorbidity or need for respiratory support, may benefit from early ASD closure in order to improve their clinical status [ 11 , 12 ]. Refinements in the device configuration and material used during catheterization have contributed to improved procedural safety even in small children with severe clinical picture [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg

et al. 2016

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Atrial septal defect (ASD) is the most common congenital cardiac lesion accounting for 10–15% of all cardiac malformations. In the majority of cases, the secundum type of the ASD is closed percutaneously in the catheterization laboratory. Although transcatheter closure of ASD is considered safe and effective in pediatric patients, there are limited data regarding the efficacy and safety of device ASD closure in smaller infants. The aim of this study was to determine risk of complications within 72 h following device closure of ASD in children of body weight <15 kg compared to larger children. Overall 252 children who underwent transcatheter closure of ASD at Children’s Heart Centre in Lund, Sweden, between 1998 and 2015 were included. Data regarding demographics, comorbidity and complications occurring during and after device procedure until discharge were retrieved from the hospital’s databases. Echocardiographic data were obtained from the digital and videotape recordings. Nearly half of the study cohort (n = 112; 44%) had a procedural weight <15 (median 11.3) kg with a median procedural age of 2.02 years. Among this study group, 22 (9%) children had post-procedural in-hospital complications, of which 16 (7%) were considered as major and six (2%) considered as minor. No deaths occurred. There was no significant difference in of the occurrence of major or minor complications between the two groups (p = 0.32). Larger ASD was more often associated with minor complications, OR 1.37 (95% CI 0.99–1.89), which most often consisted of transient arrhythmias during or after the procedure. Percutaneous ASD device closure can be performed safely in low-weight infants with a risk of post-procedural in-hospital complications comparable to larger/older children. Nevertheless, careful considerations of the indications to device closure is needed, particularly in children with larger ASD, as recommended by the current international guidelines for ASD closure.

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Section: Introductionmentioning

confidence: 99%

Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg

et al. 2016

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“…One study suggested that children with comorbidities combined with large atrial shunts may worsen in clinical status, and thus may benefit from an early atrial septal defect closure. 35 Atrial shunts due to atrial septal defect and persistent foramen ovale are present in 40% of children with very low birth weights and are five times more common among very preterm-than term-born children. 35 The clinical impact and natural course of atrial shunts in children born prematurely remain unclear.…”

Section: Discussionmentioning

confidence: 99%

“…35 Atrial shunts due to atrial septal defect and persistent foramen ovale are present in 40% of children with very low birth weights and are five times more common among very preterm-than term-born children. 35 The clinical impact and natural course of atrial shunts in children born prematurely remain unclear. The majority of smaller atrial septal defects in children will spontaneously close within 1 year after diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Adverse events within 1 year after surgical and percutaneous closure of atrial septal defects in preterm children

et al. 2019

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Introduction:Atrial septal defect is the third most common CHD. A hemodynamically significant atrial septal defect causes volume overload of the right side of the heart. Preterm children may suffer from both pulmonary and cardiac comorbidities, including altered myocardial function. The aim of this study was to compare the rate of adverse events following atrial septal defect closure in preterm- and term-born children.Method:We performed a retrospective cohort study including children born in Sweden, who had a surgical or percutaneous atrial septal defect closure at the children’s hospitals in Lund and Stockholm, between 2000 and 2014, assessing time to the first event within 1 month or 1 year. We analysed differences in the number of and the time to events between the preterm and term cohort using the Kaplan–Meier survival curve, a generalised model applying zero-inflated Poisson distribution and Gary-Anderson’s method.Results:Overall, 413 children were included in the study. Of these, 93 (22.5%) were born prematurely. The total number of adverse events was 178 (110 minor and 68 major). There was no difference between the cohorts in the number of events, whether within 1 month or within a year, between major (p = 0.69) and minor (p = 0.84) events or frequencies of multiple events (p = 0.92).Conclusion:Despite earlier procedural age, larger atrial septal defects, and higher comorbidity than term children, preterm children appear to have comparable risk for complications during the first year after surgical or percutaneous closure.

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“…24,25 Lee et al in their study have shown the need for oxygen dependency among premature infants to be higher in those with interatrial communications. 26 Several case reports have also indicated an association between left-to-right shunt at atrial level and persistent respiratory support in the setting of chronic lung disease. 27,28 It has been suggested that in these cases, increased pulmonary blood flow may exacerbate pulmonary oedema, commonly seen in such infants, aggravate endothelial injury and contribute to the development of pulmonary vascular disease.…”

Section: Effect Of Early Atrial Septal Defect Repair On Clinical Outcmentioning

confidence: 99%

Repair of isolated atrial septal defect in infants less than 12 months improves symptoms of chronic lung disease or shunt-related pulmonary hypertension

et al. 2020

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Introduction:Infants with isolated atrial septal defects are usually minimally symptomatic, and repair is typically performed after infancy. Early repair may be considered if there is high pulmonary blood flow and reduced respiratory reserve or early signs of pulmonary hypertension. Our aim was to review the characteristics and outcomes of a cohort of patients who underwent infant repair at our institute.Methods:The study included 56 infants (28 female, 19 trisomy 21) with isolated atrial septal defect (age: 8 months (1.5–12), weight: 6 kg (2.8–7.5), echo Qp/Qs: 1.9 ± 0.1) who underwent surgical closure (20 fenestrated). Three groups were identified: 1) chronic lung disease and pulmonary hypertension (group A: n = 28%); 2) acutely unwell infants with pulmonary hypertension but no chronic lung disease (group B: n = 20, 36%); and 3) infants with refractory congestive heart failure without either pulmonary hypertension or chronic lung disease (group C: n = 9, 16%).Results:Post-operatively, pulmonary hypertension infants (47/56) showed improvement in tricuspid annular plane systolic excursion z-score (p < 0.001) and right ventricular systolic/diastolic duration ratio (p < 0.05). All ventilator (14.3%) or oxygen-dependent (31.6%) infants could be weaned within 2 weeks after repair. One year later, weight z-score increased in all patients and by +1 in group A, +1.3 in group B and +2 in group C. Over a median follow-up of 1.4 years, three patients died, four patients continued to have pulmonary hypertension evidence and two remained on targeted pulmonary hypertension therapy.Conclusion:Atrial septal defect repair within the first year may improve the clinical status and growth in infants with early signs of pulmonary hypertension or those requiring respiratory support and facilitate respiratory management.

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Clinical Characteristics and Outcome of Incidental Atrial Septal Openings in Very Low Birth Weight Infants

Cited by 10 publications

References 41 publications

Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg

Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg

Adverse events within 1 year after surgical and percutaneous closure of atrial septal defects in preterm children

Repair of isolated atrial septal defect in infants less than 12 months improves symptoms of chronic lung disease or shunt-related pulmonary hypertension

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