Complications after percutaneous device closure of atrial septal defects in children: Prevalence, outcomes and associated factors.

Transcatheter closure of atrial septal defect (ASD) in older children and adults is currently considered the first-choice therapeutic option. This approach remains challenging in younger children. The aim of the study was to evaluate feasibility, safety and midterm efficacy of percutaneous ASD closure in symptomatic infants ≤10 kg body weight in our institution. There were 28 children up to 10 kg of body weight, who were qualified for transcatheter closure of ASD. All patients but one showed overload of right atrium and right ventricle. Mean weight of patients who underwent transcatheter closure was 9.2 ± 0.88 kg and age 1.59 ± 0.58 years, respectively. Transcatheter closure of ASD was conducted using Amplatzer occluders (ASO). The devices were implanted successfully in 26/28 patients (93%). In 2 (7%) children the device repeatedly straddled the septum in relatively big ASD and the procedure was abandoned. Mean ASD diameter in patients, who underwent transcatheter closure, was 9.08 ± 2.9 mm (transthoracic echocardiography) and mean implant size/weight ratio was 1.07 ± 0.31. In the child with right-left shunt through ASD normalization of saturation occurred. Mean fluoroscopy time was 4.16 min. In 3 children minor complications occurred: transient arrhythmias (n = 1), fever after procedure (n = 2). The follow-up time was 6.1 (range 1.2-11) years. At follow-up, clinical condition and/or growth improved in all patients except 4 children with coexisting comorbidity. No arrhythmia nor conduction disturbances were observed during follow-up. In selected patients weighing less or equal to 10 kg, percutaneous closure of ASD is a safe and effective procedure.

To report our experience of transcatheter closure (TCC) of large atrial septal defects (ASDs) in children using the left atrial (LA) disc engagement-disengagement technique (LADEDT). This is a retrospective study comprising 21 children diagnosed with large secundum ASDs. All of them had an attempt at TCC with the Amplatzer septal occluder (ASO) using LADEDT. They were assessed by clinical examination, ECG and echocardiography before the procedure, at 24 hours, 6 weeks, 6 months, and every 1 year after the device closure. The median age of the cohort was 3 years (range 1-12 years). The weight ranged from 5 to 40 kg (median = 12 kg). The mean ASD diameter was 16.7 ± 4.3 mm. The median device size used was 22 mm (range 15-40 mm). The device was successfully placed from the superior pulmonary vein (left: 12; right: 4) and the LA appendage (LAA) in 2. In three patients the technique failed and we had to resort to the balloon assisted technique (BAT) for a successful deployment. The number of attempts for deployment ranged from 1 to 4 (median 2). Despite appropriate placement, the device was not released in one patient because of deficient and floppy inferior margin. One patient had worsening of mitral regurgitation from mild to moderate grade without further progression till last follow up. There were no other major complications during the follow up (6.2 ± 2.4 months) period. TCC of large ASDs in small children using the LADEDT is predictable, reproducible, relatively simple, safe, and effective.

Device Closure of Secundum Atrial Septal Defects in Children <15 kg: Complication Rates and Indications for Referral

Transcatheter Versus Surgical Closure of Atrial Septal Defects in Children: A Value Comparison.

Speed of normalization of right ventricular volume overload after transcatheter closure of atrial septal defect in children and adults

Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: Results of a multicenter nonrandomized trial

Retrograde aortic perfusion dislodges a dislodged Amplatzer device

ObjectiveAlthough transcatheter atrial septal defect (ASD) closure has become the preferred treatment for ostium secundum ASD, closure of complex defects—characterized by large size, rim deficiencies, multiple fenestrations, aneurysmal or malaligned septum, or low body weight—remains technically challenging. This study evaluated the efficacy of transcatheter closure in children with complex ASDs.Materials and MethodsThis retrospective single-center study included 15 patients aged 0–18 years who underwent transcatheter ASD closure between 2023 and 2025. All procedures were performed using the Occlutech Figulla Flex II ASD occluder and were guided by transthoracic and transesophageal echocardiography. Procedural data, complications, and follow-up outcomes were recorded.ResultsThe mean age was 7.0±4.4 years, and 60% of the patients weighed ≤15 kg. Complete occlusion was achieved in all children. Two patients (13.3%) experienced transient complications—one device embolization and one case of atrial premature beats—which resolved without permanent sequelae. No mortality or residual shunts were observed at 6-month follow-up.ConclusionTranscatheter closure of complex ASDs is safe when performed by experienced operators who conduct careful anatomical assessments and select appropriate devices. Alternative implantation techniques may enhance procedural success in challenging anatomical conditions. Transcatheter closure is a reliable, minimally invasive alternative for complex ASD cases.

Effect of catheter device closure of atrial septal defect on diastolic mitral annular motion

Large atrial septal defects (ASDs) in children cause increased volume overload of the right side of the heart which in turn lead to impairment of left ventricular (LV) performance. The aim of this study was to evaluate immediate LV rotational deformation changes in children with large ASDs post-device closure and removal of right ventricle (RV) volume overload. Twenty children who underwent transcatheter closure (TCC) of large secundum ASDs were included in the study. LV rotational deformation was assessed pre- and 24hours post-device closure using speckle tracking imaging (STI). 55% were females with mean age 6.1±3.5years. LV peak basal clockwise rotation improved significantly (-6.9±2.6° before vs -10.3±4.1° after TCC, P=.005), and time to peak clockwise rotation (345.1±124.7 milliseconds (ms) before vs 282.2±82.9ms after closure, P=.02). There was no significant difference in apical rotational parameters including peak counterclockwise rotation (P>.05 for both). LV twist (11.3±3.8° before vs 17.5±7.1° after closure, P=.001) and torsion (2.1±0.7°/cm before vs 3.1±1.2°/cm after closure, P=.01) were significantly improved, mainly as the result of improvement of LV basal rotation. LV revealed a significant increase in LV end-diastolic volumes (P=.02) 24hour after TCC with no significant change (P>.05) in end-systolic volumes after closure. Increased peak LV twisting and torsion were attributed to the improved peak systolic clockwise basal rotation after TCC of large ASDs in children.

Short-term outcomes of transcatheter closure of secundum atrial septal defect in children and adolescents: An experience of two centers in Upper Egypt

We are reporting the worldwide experience in closing atrial septal defects (ASDs) in children and adults using the Amplatzer Septal Occluder (ASO) as of July 2000. The outcome measures were safety and efficacy with special emphasis on: (1) immediate success of the ASD closure as measured by transesophageal echocardiography (TEE), (2) short- and medium-term follow-up at 24 hours and 1 and 3 months and long-term follow-up at 1, 2, and 3 years as assessed by transthoracic echocardiography (TTE); and (3) the incidence of complications. In all, 3580 procedures were performed in 3535 patients. In 75 patients, the device was not implanted for variety of reasons; 3460 patients received a single ASO device and 45 received two devices for multiple ASDs. The median age of the patients was 12.1 year, (range, 10 days-88 years, the median weight was 41.0 kg (range, 2.4-137 kg) and the median Qp/Qs ratio was 2 (range, 0.3-10). The median size of ASD by TEE was 14 mm (range, 1-38 mm) and the median stretched diameter was 18 mm (range, 4-44 mm). The median size of device implanted was 18 mm (range, 4-40 mm). The median fluoroscopy time was 17.1 minutes (range, 0.0-194.0 minutes). The immediate success rate including those patients with complete closure, trivial residual shunt, or with small residual shunt was 97.4%. This increased to 99.2% and 100% at 3 months and 3 years, respectively. Minor complications were encountered in 2.8% of procedures, while serious complications occurred in less than 0.3% of the cases. There were no device related deaths. We conclude that the ASO is a safe and effective device for catheter closure of small to large ASDs up to a stretched diameter of 40 mm in children and adults with very high short-, medium, and long-term success rates.

Levels of exhaled nitric oxide before and after surgical and transcatheter device closure of atrial septal defects in children

The purpose of this study was to evaluate the safety and efficacy of transcatheter atrial septal defect (ASD) closure guided by transthoracic echocardiography (TTE). Since 2004, ASD closure was performed successfully in total 337 patients. Transthoracic echocardiography guidance was used in 206 patients (61.1%) (group 1). Closure was guided by transesophageal echocardiography under general anesthesia in patients with poor transthoracic acoustic windows, defects with aneurysmatic septum and/or multiple defects in 131 patients (38.9%) (group 2). The median age (9 vs. 16 years, P < 0.001), mean defect diameter (14.9 ± 4 vs. 17.2 ± 5 mm, P < 0.001), ratio of complex atrial septal defect (14 vs. 34%, P = 0.01), the median balloon stretch dimensions (21 vs. 18.7 mm, P = 0.003) and the median device diameters (22 vs. 19 mm, P < 0.001) were significantly greater in group 2 compared to group 1. Both the median procedure time and the median fluoroscopy time was significantly shorter in group 1 (60 vs. 75; and 13 vs. 16.5 min; P < 0.0001 and P < 0.0001, respectively). The incidence of residual shunt did not differ significantly in two groups during follow up. Transthoracic echocardiography guidance during transcatheter ASD closure is safe and effective in children and in many adults. Even complex ASDs could be closed with TTE in patients with good acoustic windows. Performing the procedure under TTE guidance significantly reduces procedure time and also provides increased patient's comfort.

We reviewed our experience using the Amplatzer septal occluder (AGA Medical, Golden Valley, MN, USA) to close large, secundum-type atrial septal defects (ASDs) in children. Between June 2002 and December 2005, 52 patients (mean age 13.5 +/- 8.7 years) underwent transcatheter closure of large (> or =25 mm), secundum ASDs with the use of the Amplatzer septal occluder (ASO). Groups 1 and 2 included patients with a retroaortic rim of <5 mm (n = 39) or > or =5 mm (n = 13), respectively. All procedures were performed with general anesthesia and transesophageal echocardiographic guidance except for 10 patients, which involved local anesthesia and three-dimensional transthoracic echocardiography. Successful device implantations, device sizes, approaches, complications, and closure rates were assessed. Device implantation was successful in 50 patients (96.1%), with no difference between groups (95% vs 100%, P>0.05). In 2 patients, implantation failed because of embolism or deployment failure. Device were larger in group 1 than in group 2 (29.7 +/- 4.2 vs 26.7 +/- 3.8 mm, P = 0.04). The right upper pulmonary-vein approach was more common in group 1 than in group 2 (P = 0.0001). Complications and closure rates did not differ between the groups (P > 0.05). Transcatheter closure of large, secundum ASD by using the ASO device was feasible, and complication rates were low. A deficient retroaortic rim did not preclude successful device implantation; however, a large device may be needed to close large ASD. Close long-term follow-up is necessary to determine the safety of transcatheter closure of large ASDs in children.