Contemporary Management of Children with Atrial Septal Defects

Abstract

Atrial septal defects that result in right atrial and ventricular volume overload should be closed if diagnosed in children and adolescents. With closure of the atrial septal defect, the left-to-right shunt is eliminated e.g. the volume loading of the right heart, the excessive pulmonary blood flow and the total cardiac work load are reduced. The possibility of future arrhythmic events is lessened and paradoxical emboli across the septum eliminated. The first intracardiac surgical repair of a congenital lesion was a defect in the atrial septum nearly 50 years ago. Surgical closure remains a valuable, although viable technique. Recently percutaneous transcatheter techniques are now available. The conventional approach is via a median sternotomy incision but is associated with pain, risk of wound infection, postoperative immobilization and a permanent scar. It has been suggested that alternative approaches such as surgical repair using mini-sternotomy or lateral thoracotomy incisions yield similar results to the conventional surgical technique and are associated with fewer adverse effects. Transcatheter closure has developed over the last two decades and has evolved into a well tolerated, efficient and cost effective method with minimal discomfort for the patients. Complete closure rates are high and this approach has become a viable option for ASD management.

Transcatheter Atrial Septal Defect Closure with the AMPLATZER® Atrial Septal Occluder in 13 Dogs: Short‐ and Mid‐Term Outcome

“…Breeds included Standard Poodle (10), Boxer (2) and Dalmatian (1). Twelve dogs were female with a mean age of 3.9 AE 2.4 (mean AE SD) and weighing 21.1 AE 3.7 kg.…”

“…1,2 In humans, small secundum-type ASD ( 5 mm) diagnosed early in life typically are benign and may undergo spontaneous size reduction with spontaneous closure reported in up to 67% of cases by 5 years of age. 2,3 In contrast, ASD is a rare canine congenital cardiovascular defect.…”

“…b Since the introduction of the Amplatzer s ASO, other disc devices for percutaneous ASD closure were developed and most recently transcatheter patch techniques also have been developed. 1,8 Recommended human patient selection criteria for transcatheter ASD closure with an ASO are predominantly related to identification of hemodynamically relevant left to right shunting ASD with adequate rim tissue. Adequate rim tissue, defined as rim tissue around a minimum of 75% of the ASD circumference, is necessary for secure release.…”

“…Evaluation of these criteria typically is dependent on a combination of transthoracic and transesophageal echocardiography (TEE) and ASD balloon sizing under fluoroscopic guidance at the time of the procedure. [1][2][3][8][9][10][11] More recently, the utility of real time 3D transthoracic and TEE has been reported to more accurately characterize the morphology of these defects.…”

Transcatheter Closure of Atrial Septal Defects: Experience of a Pediatric Heart Center

“…Transcatheter closure of ASDs has become the procedure of choice for treatment of ASDs in many centers (1,2). High success rate, low complication rate, and ease of application are the main advantages of this approach.…”