Interventional Closure of Secundum Type Atrial Septal Defects in Infants Less Than 10 Kilograms: Indications and Procedural Outcome

Wyss, Yves; Quandt, Daniel; Weber, Roland; Stiasny, Brian; Weber, Benedikt; Knirsch, Walter; Kretschmar, Oliver

doi:10.1111/joic.12328

Cited by 36 publications

(32 citation statements)

References 33 publications

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“…6 Previous reports have suggested that early atrial septal defect repair in such infants may be beneficial. 23 In our study, 48% of the infants had an underlying genetic disorder including trisomy 21 (34% of the total population). With the exception of three of these infants who had unfavourable outcome due to multiple and complex congenital defects, the rest remain well.…”

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

confidence: 53%

“…Previously published case series have also reported improvement in the respiratory status and growth of older children with chronic lung disease after atrial septal defect repair. 7,10,22,23 However, our study included the largest so far studied cohort of preterm infants with chronic lung disease who underwent atrial septal defect repair at less than 1 year of age. Indeed, almost half of the included in our study infants (48%) had an underlying diagnosis of prematurity and chronic lung disease.…”

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

confidence: 99%

“…In fact, atrial septal defect has been previously related to failure to thrive even in asymptomatic children, and catch-up growth has been shown for them after atrial septal defect repair. 23,31,32 Interestingly, Rhee et al showed that children who had atrial septal defect repair at an older age had a lesser degree of height improvement when compared with those who had the same procedure during infancy. 31 • Early atrial septal defect repair and genetic syndromes Infants with trisomy 21 or other genetic syndromes often present multi-system abnormalities including respiratory dysfunction and poor growth.…”

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

confidence: 99%

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

confidence: 53%

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

confidence: 99%

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

confidence: 99%

See 1 more Smart Citation

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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“…24,25 These studies have assessed several risk factors but have not included neonatal factors and comorbidities associated with preterm birth. [26][27][28] The combination of cardiac alterations and neonatal morbidity may have an aggravating synergistic effect and potentially contribute to an increased risk of adverse events after atrial septal defect closure. 11,12 It is well known that there are technical difficulties inherent in percutaneous device closure in smaller children, and thus surgical closure might have been the choice of preference in smaller children in our study.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for adverse events within one year after atrial septal closure in children: a retrospective follow-up study

et al. 2019

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Introduction:Secundum atrial septal defect is one of the most common congenital heart defects. Previous paediatric studies have mainly addressed echocardiographic and few clinical factors among children associated with adverse events. The aim of this study was to identify neonatal and other clinical risk factors associated with adverse events up to one year after closure of atrial septal defect.Methods:This retrospective case–control study includes children born in Sweden between 2000 and 2014 that were treated surgically or percutaneously for an atrial septal defect. Conditional logistic regression was used to evaluate the association between major and minor adverse events and potential risk factors, adjusting for confounding factors including prematurity, neonatal sepsis, neonatal general ventilatory support, symptomatic atrial septal defects, and pulmonary hypertension.Results:Overall, 396 children with 400 atrial septal defect closures were included. The median body weight at closure was 14.5 (3.5–110) kg, and the median age was 3.0 (0.1–17.8) years. Overall, 110 minor adverse events and 68 major events were recorded in 87 and 49 children, respectively. Only symptomatic atrial septal defects were associated with both minor (odds ratio (OR) = 2.18, confidence interval (CI) 95% 1.05–8.06) and major (OR = 2.80 CI 95% 1.23–6.37) adverse events.Conclusion:There was no association between the investigated neonatal comorbidities and major or minor events after atrial septal defect closure. Patients with symptomatic atrial septal defects had a two to four times increased risk of having a major event, suggesting careful management and follow-up of these children prior to and after closure.

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“…However, the closure of ASD at a young age may be beneficial, especially for preterm infants [2][3][4]. The closure of ASD must be performed in advance for young patients with congestive heart failure, frequent respiratory infection, failure to thrive, or significantly elevated pulmonary arterial pressure [5,6]. Traditional surgical closure that requires extracorporeal circulation is safe, effective, and feasible for nearly all patients with ASD [7].…”

Section: Introductionmentioning

confidence: 99%

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Han¹,

Zhang²,

Zhang³

2020

J Cardiothorac Surg

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Background: Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age. Methods: From September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively. Result: The mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up. Conclusion: Transcatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.

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Interventional Closure of Secundum Type Atrial Septal Defects in Infants Less Than 10 Kilograms: Indications and Procedural Outcome

Abstract: Interventional ASD closure in children weighing less than 10 kg can be performed without any additional major risks and shows a favorable outcome, especially in selected patients with significant non cardiac co-morbidities.

Cited by 36 publications

References 33 publications

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

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

Risk factors for adverse events within one year after atrial septal closure in children: a retrospective follow-up study

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

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