Atrial Septal Defect In Infants Research Articles

Atrial Septal Stenting - A Lifesaving Procedure: First Case Report from Bangladesh

Certain congenital heart defects require the creation of an unrestrictive atrial septal defect (ASD) secundum to achieve adequate atrial mixing to improve systemic oxygen saturation by placing septal stent. We reported a case of 7-month-old child who was presented with shock like state with marked desaturation. He was diagnosed as a case of mixed total anomalous pulmonary venous return with restricted closing ASD secundum. We performed atrial septal stenting as a palliative procedure for saving the life. Creation or enlargement of ASD in infants using nonconventional transcatheter techniques is feasible, safe, and effective when usual technique fails or not suitable. After the procedure systemic saturation improved and patient became hemodynamically stable and there after rerouting of pulmonary veins to left atrium with ASD closure and removal of stent done by open heart surgery and send him home safely.
 Cardiovasc. j. 2020; 13(1): 86-91

Percutaneous atrial septal defect closure in infant weighing <10 kg and having a bilateral superior vena cava: a case report

Percutaneous closure has become a preferred treatment for secundum atrial septal defect (ASD). However, this approach remains challenging in treating small infant weighing <10 kg because of procedure-related complications. The closure of ASD in other congenital anomalies, such as a bilateral superior vena cava (SVC), should be cautiously conducted. A 15-month-old boy with a body weight of 8 kg was diagnosed with secundum ASD (9–11 mm in diameter), residual pulmonary stenosis, and bilateral SVC. Transcatheter closure of ASD was successfully performed by using a 12 mm CeraFlex occluder device (Lifetech Scientific Corporation). Post-procedural examination showed good results without any impingement to the adjacent structure. Therefore,the transcatheter closure of ASD in infant weighing <10 kg and having bilateral SVC is technically feasible and safe.

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

BackgroundTranscatheter 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.MethodsFrom 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.ResultThe 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.ConclusionTranscatheter 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.

Short-Term and Midterm Follow-Up of Transthoracic Device Closure of Atrial Septal Defect in Infants

The purpose of this study was to outline the safety and feasibility of transthoracic device closure of an atrial septal defect (ASD) with a domestic occluder in infants. Sixty-eight infants underwent transthoracic device closure of an ASD at Union Hospital, Fujian Medical University, Fuzhou, China from January 2010 to January 2015. All relevant clinical data were recorded and analyzed. All patients were invited to undergo contrast transthoracic echocardiography for 12 to 60 months after ASD closure, and telephone interviews were conducted with the infants' parents to evaluate the patients' clinical status further. All patients had successful ASD occlusion using this approach. The most frequent complication was transient cardiac arrhythmia, which was easily treated or automatically recovered during the perioperative period. During the follow-up period, no recurrence, thrombosis, device embolization, valve damage, device failure, or death was reported. The total occlusion rate was 100% in the 12months of follow-up, and all patients showed significant improvement in their clinical status. From transthoracic echocardiographic data, intracardiac structure and cardiac function were significantly improved at follow-up. Transthoracic device closure of an ASD with a domestic occluder in infants is a safe and feasible technique. The short- and medium-term follow-up results were satisfactory, but long-term follow-up is required to assess the safety and feasibility of this method in infants more accurately.

Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg

Atrial septal defect (ASD) is the most common congenital cardiac lesion accounting for 10–15% of all cardiac malformations. In the majority of cases, the secundum type of the ASD is closed percutaneously in the catheterization laboratory. Although transcatheter closure of ASD is considered safe and effective in pediatric patients, there are limited data regarding the efficacy and safety of device ASD closure in smaller infants. The aim of this study was to determine risk of complications within 72 h following device closure of ASD in children of body weight <15 kg compared to larger children. Overall 252 children who underwent transcatheter closure of ASD at Children’s Heart Centre in Lund, Sweden, between 1998 and 2015 were included. Data regarding demographics, comorbidity and complications occurring during and after device procedure until discharge were retrieved from the hospital’s databases. Echocardiographic data were obtained from the digital and videotape recordings. Nearly half of the study cohort (n = 112; 44%) had a procedural weight <15 (median 11.3) kg with a median procedural age of 2.02 years. Among this study group, 22 (9%) children had post-procedural in-hospital complications, of which 16 (7%) were considered as major and six (2%) considered as minor. No deaths occurred. There was no significant difference in of the occurrence of major or minor complications between the two groups (p = 0.32). Larger ASD was more often associated with minor complications, OR 1.37 (95% CI 0.99–1.89), which most often consisted of transient arrhythmias during or after the procedure. Percutaneous ASD device closure can be performed safely in low-weight infants with a risk of post-procedural in-hospital complications comparable to larger/older children. Nevertheless, careful considerations of the indications to device closure is needed, particularly in children with larger ASD, as recommended by the current international guidelines for ASD closure.

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

This study set out to assess indications, feasibility, complications, and clinical outcome of percutaneous transcatheter device closure of atrial septal defects (ASDs) in infants with a bodyweight below 10 kg. Retrospective single center chart and echocardiography review study from 8/2005-12/2013. Twenty-eight children with ASD (13 female) with a median age of 1.15 years (0.2-2.8) and a median weight of 7.2 kg (4.5-9.9) were analyzed. Indications for early ASD closure were failure to thrive (n = 15, 54%), bronchopulmonary dysplasia (BPD) with supplemental oxygen dependency (n = 7, 25%), and genetic syndromes with suspected pulmonary hypertension (n = 12, 43%). Device implantation was successful in all patients without any periprocedural mortality or major complication. Clinical outcome after a median follow-up period of 2.1 years (0.25-7.3) revealed no residual shunt and a significant decrease of right ventricular volume load. Patients with pulmonary hypertension experienced a significant reduction of pulmonary artery/RV pressure. Patients also showed decreased supplemental oxygen dependency and less cardiac medications, but no significant "catch-up growth" in those with failure to thrive. 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.

Device closure of secundum atrial septal defects in infants weighing less than 8 kg.

This study aimed to assess the technical aspects of atrial septal defect (ASD) closure using the Amplatzer septal occluder (ASO) and the Gore Helex septal occluder (GHSO) for infants weighing less than 8 kg and to determine the safety, effectiveness, and near-to-intermediate-term outcome of the closure. The Mid-Atlantic Group of Interventional Cardiology Registry of percutaneous, transcatheter ASD closure procedures was reviewed for this analysis. Patients from 10 hospitals in the United States were included. The cohort for this report consisted of 68 patients weighing less than 8 kg (range, 2.3-7.8 kg; mean, 5.5 ± 1.6 kg) and ranging in age from 1 to 24 months (mean, 8.6 ± 4.7 months). The indications for ASD closure were failure to thrive, significant right heart enlargement, shunts otherwise thought to be hemodynamically significant, and poor overall clinical status. Devices were successfully implanted in 66 of the 68 infants (97.1 % procedural success rate). Five minor procedure-related complications occurred. At follow-up assessment, clinical status had improved significantly as measured by improved weight gain and decreased ventilator or oxygen dependence. All residual shunts spontaneously closed during the follow-up period. Six late deaths occurred, none of which were clearly device related. The ASO and GHSO can be safely and effectively implanted for ASD closure in infants weighing less than 8 kg. These procedures usually are successful and seldom complicated, resulting in significant clinical improvement.

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

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

TCT-770 Transcatheter Device Closure Of Atrial Septal Defect In Infants And Young Children

TCT-770 Transcatheter Device Closure Of Atrial Septal Defect In Infants And Young Children

Transcatheter Closure of Secundum Atrial Septal Defect in Infants Less than 12 Months of Age Improves Symptoms of Chronic Lung Disease

Device closure of secundum type atrial septal defects in young children has now become common with extension of this practice to children less than 1 year of age. We hypothesized that patients less than 12 months of age with moderate increases in pulmonary blood flow due to atrial septal defects may improve clinically with device closure, particularly premature infants with chronic lung disease. Thirteen patients under 12 months of age have undergone atrial septal device closure at our institution from March 2002 to July 2008, with evidence of a left to right shunt by pre-procedural echocardiogram. We evaluated concomitant conditions and device closure results. Patient charts from follow-up visits with referring pediatric cardiologists were also reviewed. Follow-up phone interviews were conducted with parents/guardians of patients who underwent device closure to further evaluate clinical change. The patient ages ranged from 3-11 months (median 7) with weight ranges of 2.9-8.3 kg (median 6.5). Defect sizes ranged from 5-15 mm (median 9). Concomitant conditions included prematurity with bronchopulmonary dysplasia (n = 8) and concern of elevated pulmonary artery pressures (n = 5). The median Qp : Qs was 1.6 with a range of 1 to 2.6. The mean pulmonary artery pressures ranged from 16 to 55 mm Hg (median 27). Eleven of 13 patients showed significant improvement in their clinical status, with a reduction in oxygen requirement (six patients) and reduced right heart pressures by echocardiogram (four patients). There were no residual defects on follow-up echocardiograms. Transcatheter closure of atrial septal defects in infants can be safe, effective, and may be indicated for situations in which the left to right shunt may be implicated as a cause of ongoing chronic lung disease. Moderate increases in pulmonary blood flow due to atrial septal defects may have a negative clinical impact regarding continuing respiratory insufficiency in these patients.

Intraoperative Device Closure of Atrial Septal Defect in Infants

We evaluated the safety and feasibility of intraoperative device closure of atrial septal defect in infants. From January 2005 to September 2009, we enrolled 32 infants with secundum-type atrial septal defect in our institution. Patients were divided into two groups: 17 patients in group I had intraoperative device closure and 15 in group II had surgical closure. Intraoperative device closure involved a minimal intercostal incision that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, and insertion of the device through a delivery sheath to occlude the atrial septal defect. The procedure was successful in all patients. In group I, the size of the implanted occluder ranged between 6 and 10 mm (mean 8.5+/-1.3 mm), and complete closure rates at 24 hours and 3 months were 94.1% and 100%, respectively. In 15 of 17 infants, minor complications occurred; transient arrhythmia (n=15) and blood transfusion (n=6). In group II, all patients needed blood transfusions and suffered from various minor complications. Follow-up at 3 to 24 months was obtained in both groups. During follow-up, clinical development and growth improved in all children with failure to thrive. There were no recurrences, thromboses, or device failures. In our comparative studies, group II had significantly longer intensive care unit stay and hospital stay than group I (p<0.001). The cost of group I was less than group II (19,816.2+/-946.7 Renminbi (the Chinese currency) vs 25,250+/-1,370.7 Renminbi, p<0.001). Intraoperative device closure of atrial septal defect is a safe and feasible technique for infants. It has the advantages of cost savings, better cosmetic results, and less trauma than surgical closure.

New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease

To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques. For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective. Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum. The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth. Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.

Atrial septal defect in infants & children

Atrial septal defect in infants & children

Usefulness of the mitral valve Z score in predicting the need to close moderate- to large-sized atrial septal defects in infants with aortic coarctation

Left ventricular anatomic substrates predisposing the development of congestive heart failure in infants with atrial left-to-right shunting after aortic coarctation repair were characterized. Mitral valve, but not aortic or left ventricular, hypoplasia correlated with the development of heart failure and the need for atrial defect closure shortly after coarctation repair.

Clinical features and management of secundum atrial septal defect in infants and children

Clinical features and management of secundum atrial septal defect in infants and children

Spontaneous closure of isolated secundum atrial septal defects in infants: An echocardiographic study

The incidence and timing of spontaneous closure of isolated secundum atrial septal defects are unknown. Twenty-nine consecutive infants under 12 months of age with clinical evidence of significant left-to-right shunting through atrial septal defects were evaluated by M-mode and two-dimensional echocardiography (2DE). All had right ventricular hypertrophy by ECG. Right ventricular, right atrial, and left atrial areas were measured and right ventricular and left atrial dimensions were obtained in all patients. Spontaneous closure of the defect in four infants was suggested by normalization of clinical examination and ECG and was documented by 2DE and M-mode echocardiography at 15 to 31 months of age. All of the remaining patients, who had suitable 2DE echocardiograms and who did not spontaneously close their defects, had enlarged right ventricular and right atrial areas. Left atrial areas were normal in the four who closed spontaneously and were large in all but three who did not close. The mean diameter of the defect was similar for all patients. The 14% incidence reported here may underestimate the true incidence of spontaneous closure, since seven patients had surgical closure, all prior to 30 months of age, the oldest age at which spontaneous closure was documented. An atrial septal flap, found in all four patients who closed spontaneously but only in 4 of the 16 patients who did not close spontaneously, may contribute in some way to spontaneous closure. Since spontaneous closure may occur up to 30 months, it seems clear that surgical closure should not be performed before that age unless medical management has failed to control symptoms.

Spontaneous closure of secundum atrial septal defect in infants and young children

The records of 264 pediatric patients with uncomplicated ostium secundum atrial septal defect (ASD) were reviewed. Eighty-seven patients were younger than age 4 years at the time of cardiac catheterization. Subnormal weight gain, frequent pneumonia, cyanosis or tachypnea were present in 26 patients (30%). Of the 36 infants at catheterization, 17 (48%) had the previously described symptoms, including 12 (33%) who had congestive heart failure. Eight of the 36 infants were found to have closed their defect at a subsequent catheterization. Six of 18 patients who underwent cardiac catheterization between 1 and 2 years of age also had spontaneously closed their ASD at subsequent study. Statistical analysis of hemodynamic data revealed no difference (except a smaller shunt size) between ASDs that closed and those that did not in patients who were <4 years at initial catheterization. Analysis of hemodynamic data revealed no statistical differences between groups of patients with an ASD who were younger than and those older than 4 years at time of diagnostic study. Patients with ASDs that closed were significantly different from patients with atrial level shunting thought to be secondary to a valve-incompetent foramen ovale with respect to age at initial study (11 versus 2 months, p <0.001), mean left atrial pressure (7.7 versus 12.3 mm Hg, p <0.02) and difference between mean right and left atrial pressures (1.0 versus 4.2 mm Hg, p <0.01). Because of this high incidence of spontaneous closure of ASD, even in symptomatic patients, intensive medical management rather than surgical correction is recommended for patients with ASD who are younger than age 2 years. Elective surgical repair of ASD diagnosed after age 4 years is recommended because spontaneous closure after that age is probably unlikely.

Symptomatic atrial septal defect in infants

Clinical and hemodynamic data obtained in seven infants with atrial septal defects who developed congestive heart failure and recurrent pneumonia during the first year of life were analyzed. Auscultatory findings were variable and were not specific for atrial septal defect. Vigorous medical management was sufficient to maintain these infants during the critical first year of life. Because of the good prognosis it is imperative to differentiate this defect from other cardiac lesions which cause large left-to-right shunts and which require early surgical intervention.

Creation of atrial septal defects.

A NEW method, which uses a specially designed septal punch, has been developed for creating atrial septal defects in the very young, critically ill patient. Although the procedure was specifically designed for creating atrial septal defects in infants with transposition of the great vessels, the technique can also be used to create an interatrial communication in cases of total anomalous pulmonary venous return. The advantages of the method are that the circulation to the right lung is not interrupted at any time and the interatrial septum can first be enlarged to compensate for small anatomical structures and, thus, ensure the creation of a large defect. The method is safe, simple, reliable, and the total operating time should not be more than 30 to 40 minutes. The Instrument: Atrial Septal Punch (Fig 1) The instrument was designed to be introduced into the right atrium through a purse string suture and then

Double-contrast angiocardiography. An experimental method for demonstrating surgically created interatrial septal defects in dogs.

Venous angiocardiography with liquid opaque medium has been generally unsuccessful in demonstrating atrial septal defects in infants, children, and adults (3). Sporadic reports of success with this method have appeared, but the experience has been so inconstant that the procedure has not been recommended for the diagnosis of this abnormality. Kjellberg et al. (4), in discussing angiocardiography in the diagnosis of atrial septal defect, state that, in their opinion, “the results of examination with intravenous injection of the contrast medium do not warrant further attempts with the technique.” The present report is concerned with our experience in demonstrating such defects in dogs by the simultaneous intravenous injection of an opaque medium and 100 per cent carbon dioxide. The method of study employed was devised after the observation of results obtained by the intracardiac injection of pure carbon dioxide, as described by Stauffer et al. (5–7, 9). These investigators obtained satisfactory visualization of the anatomy of the chambers of the heart and great vessels with this medium and cineradiography. Their experience showed this to be a relatively safe procedure in dogs, even when the carbon dioxide was injected via catheter into the chambers of the left side of the heart. Carbon dioxide in amounts as great as 7.5 c.c./kg. appeared to be well tolerated by dogs and to be absorbed rapidly in the blood stream. Limited human application was also observed without incident (2). Recently, these workers have described the visualization of an atrial septal defect in dogs by this method (5, 6) but they failed to demonstrate the defect in two patients (10). As much as 11 liters of pure carbon dioxide have been injected intravenously within a five-minute period in a dog without sequelae (8). A double-contrast technic employing carbon dioxide and Diodrast has been described by Durant et al. (2). It has provided better visualization but results in a marked depressing effect on the heart which is not noted when carbon dioxide is used alone. Recent experimental work with this method has been reported by Blickman (1). Method Thirty studies were performed on 9 normal dogs and 5 with surgically created atrial septal defects. The margins of the defect were marked with metal clips in one dog. The radiographs were made with the Schönander biplane rapid film-changing device at a speed of four per second and cineradiography (not demonstrated here) using 32 frames per second. Comparison studies were done in the prone and supine positions during the intravenous injection of a liquid opaque medium, carbon dioxide, and a combination of the two injected simultaneously. Observations Position of the Left Atrium: The left atrium was outlined in one normal dog by surgical insertion of a catheter via thoracotomy and the injection of 50 c.c. of carbon dioxide. Simultaneously, opaque medium was injected into a jugular vein.