Predictors of Spontaneous Closure of Isolated Secundum Atrial Septal Defect in Children: A Longitudinal Study

Hanslik, Andreas; Pospisil, Ulrich; Salzer‐Muhar, Ulrike; Greber‐Platzer, Susanne; Male, Christoph

doi:10.1542/peds.2005-3037

Cited by 117 publications

(84 citation statements)

References 20 publications

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“…The procedure was performed as previously described (19,(22)(23)(24) Right-sided cardiac catheterization was performed to evaluate hemodynamics and exclude additional congenital heart defects. Ten (2.6%) patients had pulmonary arterial hypertension (defined as mean pulmonary arterial pressure >25 mmHg).…”

Section: Procedures Characteristics and Per-operative Echocardiographimentioning

confidence: 99%

Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

Baruteau¹,

Hascoët²,

Fraisse³

2017

J. Thorac. Dis.

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Background: 2D-transesophageal echocardiography (TEE) is routinely performed to guide percutaneous ASD closure in children. We aimed to assess whether two-dimensional (2D)-transthoracic echocardiography (TTE) is a safe alternative for assessment and guidance of atrial septal defect (ASD) closure in unselected children.Methods: We performed a retrospective single-center study including 389 consecutive children aged Results: ASDs were larger and rims deficiencies were more frequent in the TTE-guided group. The procedure was successful in 376 patients [96.7%; 95% confidence interval (CI), 94.4-98.2%]. The success rate tended to be higher in the TTE-versus TEE-guided group (98.0% versus 94.0%, P=0.069). Device migration occurred in 4 patients (1.0%; 95% CI: 0.3-1.6%), all after TEE-guided procedure (P=0.013).Early major adverse events were observed in 5 patients (1.3%; 95% CI: 0.4-3.0%), all in the TEE group (P=0.004). Fluroroscopic time and irradiation dose were not different among the 2 groups (P=0.450 and P=0.130 respectively). After a median follow-up of 7 years (range, 1-16 years), no adverse events was reported. One (0.3%, 95% CI: 0-1.4%) 12-year-old patient developed atrial fibrillation 5 years after the procedure. Pregnancies were uneventful in 72 cases.Conclusions: When a balloon sizing is performed, 2D-TTE imaging is as efficient as 2D-TEE to guide percutaneous ASD closure in children. The procedure can safely be done in spontaneously breathing children under TTE guidance alone in experienced centers.

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Section: Procedures Characteristics and Per-operative Echocardiographimentioning

confidence: 99%

Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

Baruteau¹,

Hascoët²,

Fraisse³

2017

J. Thorac. Dis.

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“…It is caused by underdevelopment of the secundum septum or over-reabsorption of the primum septum. In most cases, ASDs close spontaneously during infancy [4,5]; however, if persistent, their clinical impact is related to their location, size, and association with other defects [5,6]. Small ASDs usually cause a left-to-right shunt without significant structural consequences in the right-sided heart chambers.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Pulmonary Function After Closure of Atrial Septal Defect in a Patient With Cystic Fibrosis

Bratincsák¹,

Rhee²,

Alstine³

et al. 2017

jshd

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Atrial septal defect (ASD) is a major cause of left-toright intracardiac shunting. If persisting into adulthood, an ASD can lead to a larger shunt, which may eventually cause pulmonary hypertension and right ventricular failure. Large intracardiac shunts cannot be tolerated in patients with underlying lung disease such as cystic fibrosis. Although the association between an intracardiac shunt and cystic fibrosis has been reported in the literature, the impact of ASD closure on the clinical course of patients with cystic fibrosis has not been studied. Here, we report a case of ASD closure in a patient with cystic fibrosis with hypoxemia out of proportion to his lung disease. Closure of the ASD shunt resulted in significant improvement of his symptoms and pulmonary function testing.Copyright © 2017 Science International Corp. Key WordsAtrial septal defect • Septal closure device • Cystic fibrosis when significant, can cause dyspnea on exertion, which may not be well tolerated in patients with an underlying pulmonary condition such as cystic fibrosis. It is unknown whether ASD closure could lead to symptomatic improvement in these patients. Here, we report a case of ASD closure resulting in improved pulmonary function testing in a patient with cystic fibrosis with a bidirectional shunt and worsening functional capacity. Case PresentationOur patient was a 36-year-old man with cystic fibrosis diagnosed at birth with a dF508/dF508 genotype. His symptoms could be characterized as moderate airway disease complicated by chronic airway infections, pancreatic insufficiency, diabetes, and malnutrition. Progression of his clinical condition caused dyspnea with minimal exertion. He was referred to our cardiology service to be evaluated for hypoxemia out of proportion to his chronic pulmonary disease. Pulmonary function testing showed a forced expiratory volume in 1 s (FEV1) of 1.71 (43% predicted). Transesophageal echocardiography (TEE) showed a small ASD with a bidirectional shunt seen at rest (Figure 1). Right heart catheterization showed a pulmonary artery pressure of 26/7/16 mmHg and pulmonary vascular resistance of 1.7 Wood units. A decision was made to proceed with ASD closure, which

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“…In addition, the strongest predictor for spontaneous closure was shown to be smaller size at the time of initial diagnosis. In one study, over half of ASD's measuring between 4-5 mm at the time of diagnosis closed spontaneously and an additional 30% regressed to a size considered to be insignificant (≤ 3 mm) (Hanslik et al, 2006). None of the larger defects (> 10 mm) closed spontaneously and over 75% required surgical or device closure (Hanslik et al, 2006).…”

Section: Natural History Of Secundum Asdmentioning

confidence: 99%

“…In one study, over half of ASD's measuring between 4-5 mm at the time of diagnosis closed spontaneously and an additional 30% regressed to a size considered to be insignificant (≤ 3 mm) (Hanslik et al, 2006). None of the larger defects (> 10 mm) closed spontaneously and over 75% required surgical or device closure (Hanslik et al, 2006). These data certainly suggest that size of the secundum ASD at initial diagnosis directly impacts the natural history and specifically the potential need for closure.…”

Section: Natural History Of Secundum Asdmentioning

confidence: 99%

Prevalence of Secundum Atrial Septal Defect and Associated Findings

Reller¹

2012

Atrial Septal Defect

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Predictors of Spontaneous Closure of Isolated Secundum Atrial Septal Defect in Children: A Longitudinal Study

Abstract: In the present study population of children with atrial septal defects, 62% showed spontaneous closure (34%) or regression to < or = 3 mm (28%). Initial atrial septal defect diameter was the main predictor of spontaneous closure.

Cited by 117 publications

References 20 publications

Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

Improvement in Pulmonary Function After Closure of Atrial Septal Defect in a Patient With Cystic Fibrosis

Prevalence of Secundum Atrial Septal Defect and Associated Findings

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