298 Percutaneous closure of atrial septal defects in children: what are the predictive factors of success?

Abstract

Percutaneous atrial septal defect (ASD) closure is now a safe and efficient alternative to surgery in adults. In paediatric population, its feasibility is still uncertain and limited in young children with large defect. Our aim was to determine predictive factors of success of percutaneous ASD closure in this population. All patients less than 12 years-old who underwent an attempt of a percutaneous ASD closure using Amplatzer septal occluder device were retrospectively reviewed. We analysed by echocardiography ASD diameter, length of rims surrounding, length of atrial septum, and during catheterization balloon-stretched diameter. ASD area was calculated and normalized to the body surface area of patients. The procedure was abandoned when the device placement failed after three attempts. 140 patients (age 7.7 ± 2.5 years, weight 25.3 ± 9 kg) were included. Echocardiographic ASD diameter was 15 ± 4.1 mm, balloon-stretched diameter 19.8 ± 4.7 mm, length of atrial septum 34.8 ± 5.9 mm, diameter of implanted device 18.6 ± 4.3 mm. All rims surrounded ASD measuring at least 3 mm. Percutaneous closure was successfully performed in 131 patients and failed in 8 patients. One device embolization into right atria occurred without any complication leads to surgery. Predictive factors of success included smaller ASD echocardiographic and balloon-stretched diameters (14.6 ± 3.8 vs 19.9 ± 4.4 mm, p<0.001 and 19.0 ± 0.6 vs 25.6 ± 6.3 mm, p<0.001), smaller ratio ASD area/body surface area (338 ± 139 vs 569 ± 210, p<0.05), smaller device size (18.3 ± 3.9 vs 22.4 ± 5.7 mm, p<0.05), and smaller gap between balloon-stretched and implanted device diameters (−1.0 ± 0.6 vs 3.1 ± 2.8 mm). Percutaneous ASD closure using Amplatzer device is feasible and safe in most of children. Small ASD and an appropriate size device are predictive of success. In the larger ASD and in the younger patients, normalization of ASD area to body surface area may help to choice the best treatment.