293: Transcatheter closure of ASD in infancy with the Amplatzer septal occluder

Abstract

Many devices are available for atrial septal defect (ASD) usually in adults and children. We report here one center experience in transcatheter closure of ASD in infancy, using the Amplatzer septal occluder. From January 2003 to March 2010, 10 males and 5 female, mean age 10.9±6.4 months, with weight 6.7±2.5 kg underwent transcatheter closure of atrial septal defect. The patients had significant left-to-right shunting (n=12), right-to-left shunting with hypoxemia (n=3). For the left-to-right shunting, the ASD was closed for pulmonary hypertension (n=10), for recurrent chest infection and bronchiolitis (n=5). The ASD was associated with other congenital heart defect (n=5), prematurity and bronchopulmonary dysplasia (n=6), foetopathy (n=1) and encephalopathy (n=1). The ASD was evaluated by transthoracic echocardiography (TEE) before the procedure. Percutaneous closure was realized with TEE for all patients. They received intravenous heparin. For 4 patients implantation was performed after a balloon test occlusion (mean 11±3.4 mm diameter). The ASO device size was 10.4±3.9 mm. The fluoroscopy time was 7.9±3.9 minutes and the time of the procedure 55.6±21.8 minutes. No per procedural complications were observed for all but for two (one anomalous device deployment and one insufficient rim). These two patients were subsequently surgically repaired. Patients left the hospital with a low dose of aspirin for 6 months. During follow-up, four patients had a minimal residual shunt on TEE performed up to one year after the implantation. No later cardiac complication was observed. To conclude, transcatheter closure of atrial septal defect in infant with the ASO is feasible and a possible alternative to surgical closure. In addition, ASD occlusion improves the respiratory status and reduces the level of pulmonary hypertension. Additional long-term results and a large study are both necessary to establish the future of this population