Septal Defect In Infants Research Articles

Del Nido versus cold crystalloid cardioplegia for myocardial protection during ventricular septal defect repair in children under one year of age: a prospective randomized trial

Rationale: The choice of strategy for myocardial protection during procedures with cardiopulmonary bypass and cardioplegic arrest in children is not regulated by clinical guidelines due to insufficient data from clinical studies. The issue of methods to assess myocardial injury remains unresolved.
 Aim: To assess the frequency and specifics of the development of intraoperative myocardial injury syndrome in children of the first year of life with ventricular septal defect depending on the strategy for cardioplegia.
 Materials and methods: In a single center, prospective, randomized controlled trial we compared two cardioplegia strategies during surgical closure of ventricular septal defect in infants aged from 1 to 12 months: del Nido blood cardioplegia (n = 102) and cold crystalloid cardioplegia with Custodiol solution (n = 102). The primary endpoint was a persistent over 10-fold increase above the upper limit of the normal in the plasma concentration of high-sensitivity troponin I at 6 hours after surgery persisting after 24 hours. The secondary combined endpoint was myocardial damage verified by persistent increase in troponin I level more than 10-fold above the upper limit of the normal, persisting at 6 and 24 hours, accompanied by new pathological Q waves, acute complete left bundle branch block, abnormalities of the end part of the ventricular complex on the electrocardiography (ST segment elevation 1 mm or ST depression of 1 mm in more than 2 adjacent leads), and a decrease in the global longitudinal strain of the left ventricle by 50% from the initial value at 6 hours after surgery.
 Results: In 53/204 (26%) patients, the increase in troponin I persisted at 24 hours after the surgery and was associated with electrocardiography abnormalities, changes in the parameters of left ventricle longitudinal mechanics, and in some cases required greater inotropic support. By the end of the 1st postoperative 24 hours, the longitudinal strain of the left ventricle showed more negative changes over time in the Custodiol group compared to that in the del Nido group (-10 [-14.1; -6.27] versus -14.8 [- 16.5; -10]%; p 0.0001). The same was true for the left ventricle global strain rate (-0.71 [-0.9; -0.52] s-1 in the del Nido group and -0.57 [-0.760; - 0.44] s-1 in the Custodiol group; p = 0.0049). The primary endpoint was achieved by 21 (20.6%) and 55 (53.9%) patients in the del Nido and Custodiol groups, respectively (p = 0.032). The combined endpoint in the Custodiol group was achieved by 34 (33.3%) versus 19 (18.6%) patients in the del Nido group (p = 0.049, χ2 = 3.875, DF = 1, φ = 0.191).
 Conclusion: Del Nido blood cardioplegia compared to cold crystalloid cardioplegia with Custodiol has advantages in terms of preventing intraoperative myocardial damage and minimizing its severity. When assessing myocardial damage, such indicators as left ventricle global longitudinal strain and left ventricle global strain rate are informative, along with an increase in the troponin I level.

Left Ventricular Dysfunction Following Repair of Ventricular Septal Defects in Infants.

Left ventricular systolic dysfunction (LVSD) is frequently observed following repair of ventricular septal defects (VSD), although little is known about its incidence, time course, or risk factors. Among infants undergoing VSD repair, for postoperative LVSD, we sought to determine (1) incidence, (2) predictors, and (3) time to resolution. We queried our institution's surgical database for infants who underwent repair of isolated VSDs from November 2001 through January 2019. The primary outcome was postoperative LVSD, which was defined as a shortening fraction (SF) of <26% by M-mode. Postoperative echocardiograms were reviewed, and measurements were made using standard methods. Receiver operating characteristic analysis was generated to determine the preoperative left ventricular internal dimension (LVIDd) z-score most predictive of LVSD. Multivariable analysis was conducted to determine associations with LVSD; covariates in the model were weight percentile, genetic syndrome, preoperative diuretic, VSD type, and preoperative LVIDd z-score. Of the 164 patients who met inclusion criteria, 62 (38%) had postoperative LVSD. Fifty-eight (94%) of patients had resolution of LVSD within 9months of surgery. Preoperative LVIDd z-score of >3.1 was associated with both an increased incidence of postoperative LVSD and prolonged time to resolution. Multivariable logistic regression analysis showed only preoperative LVIDd z-score was independently associated with postoperative LVSD. LVSD following VSD closure is common, but nearly all cases resolve by 9months postoperatively. Elevated LVIDd prior to surgery is associated with postoperative LVSD. These data suggest VSD closure should be considered prior to the development of significant left ventricular dilation.

The Interventricular Septal Hematoma Following Surgical Correction of Ventricular Septal Defect in Infants: A Single-Center Experience.

To review and analyze the cases of interventricular septal hematoma (IVSH) following surgical correction of the ventricular septal defect (VSD) in infants in our center. Retrospective analysis was performed on five infants with IVSH after surgical correction of VSD in our center from January 2020 to January 2022. The general preoperative information and intraoperative and postoperative results were collected and analyzed. All five infants with VSD were repaired under cardiopulmonary bypass and occurred IVSH. The cardiac arrest occurred in one patient five hours after return to the intensive care unit (ICU). The patient's hemodynamics were difficult to maintain after cardiopulmonary resuscitation, and the patient died. Two other patients had arrhythmia and unstable hemodynamics during the perioperative period, the hematoma puncture was performed, and the patients' symptoms lessened. Perioperative and postoperative echocardiography showed that the hematoma gradually was shrunk, and the hemodynamics became stable. The hemodynamics were stable in the remaining two infants during the perioperative period. No specific medical intervention was required other than clinical observation in these two patients. Finally, the four infants successfully were discharged with good clinical results. IVSH is a rare complication of surgical repair of VSD. Prevention and early detection of IVSH during operation in infants with VSD are essential.

A comparison of autologous pericardium with Dacron™ for closure of ventricular septal defect in infants.

Glutaraldehyde-treated autologous pericardium (GtAP) and Dacron™ are 2 patch materials commonly used to repair ventricular septal defects (VSDs) in children. The primary objective of this study was to test the hypothesis that GtAP is as effective as Dacron for the repair of isolated VSD in infants. Data were collected retrospectively from all infants who underwent repair of isolated VSD at our institution between January 2009 and April 2017. A total of 156 patients were divided into 2 groups: 99 underwent repair with Dacron patch and 57 with GtAP. The primary end point was the need for reintervention for significant residual VSD. Adjusted hospital charges were also compared. The 2 groups were comparable in their baseline characteristics. There was no significant difference in postoperative morbidity indicators. One patient in each group underwent reintervention for the closure of residual VSD. The GtAP group had a higher incidence trivial and small residual VSD at discharge than the Dacron group (65% vs 39%, P = 0.007). The median duration of follow-up was 37 (15-75) months with no difference between the 2 groups. Forty-five percentage of the residual VSDs in the Dacron group (19/42) and 54%in the GtAP group (21/39) had closed. There was no difference in hospital charges and clinical outcomes. GtAP for the closure of isolated VSD in infants is comparable to Dacron. Although the incidence of trivial or small residual VSD is higher with the use of pericardium immediately after surgery, this difference disappears over time.

Long-Term Outcome Up To 40 Years after Single Patch Repair of Complete Atrioventricular Septal Defect in Infancy or Childhood.

Objectives Patients with repaired complete atrioventricular septal defect (CAVSD) represent an increasing portion of grown-ups with congenital heart disease. For repair of CAVSD, the single-patch technique has been employed first. This technique requires division of the bridging leaflets, thus, among other issues, long-term function of the atrioventricular valves is of particular concern. Methods Between 1978 and 2001, 100 consecutive patients with isolated CAVSD underwent single-patch repair in our institution. Hospital mortality was 11%. Primary endpoints were clinical status, atrioventricular valve function, and freedom from reoperation in long term. Follow-up was obtained contacting the patient and/or caregiver, and the referring cardiologist. Results Eighty-three patients were eligible for long-term follow-up (21.0 ± 8.7, mean ± standard deviation [21.5; 2.1–40.0, median; min–max] years after surgical repair). Actual long-term mortality was 3.4%. Quality of life (QoL; self- or caregiver-reported in patients with Down syndrome) was excellent or good in 81%, mild congestive heart failure was present in 16%, moderate in 3.6% as estimated by New York Heart Association classification. Echocardiography revealed normal systolic left ventricular function in all cases. Regurgitation of the right atrioventricular valve was mild in 48%, mild–moderate in 3.6%, and moderate in 1.2%. The left atrioventricular valve was mildly stenotic in 15% and mild to moderately stenotic in 2%; regurgitation was mild in 54%, mild to moderate in 13%, and moderate in 15% of patients. Freedom from left atrioventricular-valve-related reoperation was 95.3, 92.7, and 89.3% after 5, 10, and 30 years, respectively. Permanent pacemaker therapy, as an immediate result of CAVSD repair ( n = 7) or as a result of late-onset sick sinus syndrome ( n = 5), required up to six reoperations in single patients. Freedom from pacemaker-related reoperation was 91.4, 84.4, and 51.5% after 5, 10, and 30 years, respectively. Conclusion Up to 40 years after single-patch repair of CAVSD, clinical status and functional results are promising, particularly, in terms of atrioventricular valve function. Permanent pacemaker therapy results in a life-long need for surgical reinterventions.

Application of the WeChat platform in midterm follow-up after surgical repair of ventricular septal defects in infants.

To explore the feasibility and superiority of applying the WeChat platform in a midterm follow-up of surgical repair for ventricular septal defects in infants. Eighty-six infants with VSD who underwent surgical repair were divided into an outpatient follow-up group and a WeChat follow-up group. The clinical data, including complications, economic cost, time spent, loss to follow-up rate, and parents' satisfaction at the 3-month and 1-year follow-ups, were recorded and analysed. There was no significant difference in the incidence of post-operative complications between the two groups. Although the loss to follow-up rate in the WFU group was lower than that of the OFU group, the difference was not statistically significant. The economic cost and time spent in the 3 months and 1 year after discharge in the WFU group were significantly lower than those in the OFU group. One year after discharge, the PSQ-18 score of the WFU group was significantly higher than that of the OFU group. Compared with outpatient follow-up, the WeChat platform at the midterm follow-up after surgical repair of VSDs in infants has the advantages of saving time and economic costs and improves parents' satisfaction.

Long-term neurodevelopmental effects of intraoperative blood pressure during surgical closure of a septal defect in infancy or early childhood.

Many children born with congenital heart defects are faced with cognitive deficits and psychological challenges later in life. The mechanisms behind are suggested to be multifactorial and are explained as an interplay between innate and modifiable risk factors. The aim was to assess whether there is a relationship between mean arterial pressure during surgery of a septal defect in infancy or early childhood and intelligence quotient scores in adulthood. In a retrospective study, patients were included if they underwent surgical closure of a ventricular septal defect or an atrial septal defect in childhood between 1988 and 2002. Every patient completed an intelligence assessment upon inclusion, 14-27 years after surgery, using the Wechsler Adult Intelligence Scale Version IV. A total of 58 patients met the eligibility criteria and were included in the analyses. No statistically significant correlation was found between blood pressure during cardiopulmonary bypass and intelligence quotient scores in adulthood (r = 0.138; 95% CI-0.133-0.389). Although amongst patients with mean arterial pressure < 40 mmHg during cardiopulmonary bypass, intelligence quotient scores were significantly lower (91.4; 95% CI 86.9-95.9) compared to those with mean arterial pressure > 40 mmHg (99.8; 95% CI 94.7-104.9). Mean arterial pressure during surgery of ventricular septal defects or atrial septal defects in childhood does not correlate linearly with intelligence quotient scores in adulthood. Although there may exist a specific cut-off value at which low blood pressure becomes harmful. Larger studies are warranted in order to confirm this, as it holds the potential of partly relieving CHD patients of their cognitive deficits.

Percardiac closure of large apical ventricular septal defects in infants: Novel modifications and mid-term results.

Background/AimBoth open heart surgery and percutaneous approaches retain several limitations in closing large apical muscular ventricular septal defects (AmVSD) in infants. We present probe‐assisted percardiac device closure (PDC), an exclusively transoesophageal‐echocardiography guided technique, as an alternative with midterm results.MethodsThirty‐six infants with large AmVSDs (single or multiple‐holed) underwent PDC in our department. Mean AmVSD for single and multiple‐holed measured 7.2 ± 2.4 mm and 6.3 ± 3.4 mm, respectively. Subjects presented with a spectrum of cardiopulmonary sequelae and growth retardation, either alone or combined. Some were ventilator dependent and re‐do cases. In addition, AmVSDs were categorized: cylindrical, tunnel and cave‐like shaped as per color Doppler interrogation. Pursuant to cardiac access and deployment technique, subjects were apportioned: group A; inferior median sternotomy (perventricular), B; right mini‐thoracotomy (peratrial) and C; complete median sternotomy (perventricular). Under exclusive echocardiography, the Z‐ or J probe‐assisted delivery system was utilized to access AmVSDs and implant device(s) via aforementioned techniques.ResultsForty‐two muscular ventricular septal devices (8.4 ± 2.6 mm) were implanted in 36 subjects uneventfully. Seventeen “complex,” and 10 cylindrical or straight tunnel‐shapedAmVSDs (including 2 re‐do patients) suited perventricular and peratrial techniques respectively. Comparatively, group B exhibited shorter procedural indices than A (p < .01). Five of 15 multiple‐holed AmVSDs (four Swiss cheese) required two or three devices for a satisfactory occlusion. Nevertheless, post occlusion insignificant residual shunts( ≤ 2 mm) seldom achieved spontaneous closure, and at 36‐month follow‐up complete closure was 67%. Residual shunt persisted amongst multiple‐holed. All patients improved during follow up.ConclusionPDC is feasible, safe and effective alternative technique for AmVSD in infants.

The choice of tactic for surgical treatment of aortic arch hypoplasia with ventricular septal defect in infants

Aim: to determine the optimal tactic for surgical correction of aortic arch hypoplasia and ventricular septal defect (VSD) in infants based on the comparison of immediate and follow-up outcomes of one- and two-stage repair.Materials and methods. Between 2011 to 2019, 138 patients under the age of one year underwent surgical repair of aortic arch hypoplasia with VSD in the leading Ukrainina cardiosurgical institutions – National M. Amosov Institute of Cardiovascular Surgery Affilated to National Academy of Medical Sciences of Ukraine and Center for Pediatric Cardiology and Cardiac Surgery. Patients were divided into two groups: group I involved 66 (47.8 %) patients who underwent one-stage repai of aortic arch hypoplasia and VSD, group II included 72 (52.2 %) patients with two-stage repair, consisting of aortic arch reconstruction and pulmonary banding at the first stage, and correction of VSD at the second stage.Results. The total hospital mortality was 3.6 % (n = 5). In group I, hospital mortality was 3.0 % (n = 2), in group II – 4.2 % (n = 3), but this difference is not statistically significant (P > 0.05). Follow-up was from 1 month to 11 years. Mortality rate over follow-up period was 0 %. Aortic arch restenosis developed in 16 (11.6 %) patients: 6 (9.1 %) patients in group I and 10 (13.9 %) patients in group II. There was no statistically significant difference in restenosis development between two groups. Compression of the trachea and left main bronchus developed in two patients of group II (2.8 %). There were no residual VSDs which would need repeated repair.Conclusions. Both one-stage and two-stage tactic for surgical treatment of aortic arch hypoplasia with VSD in infants is effective and safe showing good immediate and long-term follow-up results. The study indicates that one- stage correction is more acceptable in infants with hypoplasia of segment C or all aortic arch segments. Stage tactic can be used in hypoplasia of segments B and A.

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.

Postoperative Recovery of Left Ventricular Function following Repair of Large Ventricular Septal Defects in Infants

Early postoperative left ventricular (LV) dysfunction is observed following repair of large ventricular septal defects (VSDs), but the frequency and rate of recovery of LV function are unknown. This study aims to characterize the incidence and rate of recovery of postoperative LV dysfunction following repair of large VSDs and to improve understanding of LV mechanics before and after VSD repair. Infants who underwent surgical repair of an isolated large VSD were included. Pre- and postoperative echocardiographic images were reviewed, and LV function was assessed by both conventional echocardiography and speckle-tracking strain analyses. Postoperative LV dysfunction was defined as an LV ejection fraction (LVEF)<50% using the 5/6 area-length method. Echocardiograms were reviewed to assess LVEF and LV volume through 1-year follow-up. Of 104 infants evaluated (median age, 0.31 [0.22, 0.56] years), all had normal preoperative LVEF and 39 (38%) had postoperative LV dysfunction. Follow-up echocardiograms were available in 31 (80%) patients, all of whom had LVEF>50% within 9months of surgery. Lower preoperative apical four-chamber longitudinal strain (A4LS) and greater LV end-diastolic volume indexed to body surface area1.38 were independently associated with postoperative LV dysfunction. An absolute preoperative A4LS < 16.7% (area under the curve=0.87; 95% CI, 0.78-0.95; P<.001) was most strongly associated with postoperative dysfunction. Infants with LV dysfunction following repair of large VSDs recover function within 9months. Preoperative A4LS can be helpful to detect subclinical LV dysfunction in the setting of a large hemodynamically significant VSD and guide postoperative expectations for providers and families.

Атрезия легочной артерии с дефектом межжелудочковой перегородки у детей первого года жизни

Атрезия легочной артерии с дефектом межжелудочковой перегородки у детей первого года жизни

Isolated ventricular septal defect in infants

Ventricular septal defect is a hole in the interventricular septum and may be isolated or associated with other major defects involving patency of the arterial duct, coarctation of aorta, pulmonary stenosis, tetralogy of Fallot, double-outlet right ventricle, truncus arteriosus, and transposition, and account for over half of the patients with congenital heart disease. Isolated ventricular septal defect is the most commonly recognized congenital heart anomaly in children and accounts for about one-fifth of all congenital heart disease. In this chapter, we’ll cover isolated ventricular septal defects.

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.

Transcatheter closure of muscular ventricular septal defect in infant with dilated cardiomyopathy

Transcatheter closure of muscular ventricular septal defect in infant with dilated cardiomyopathy

Sertraline use in the first trimester and risk of congenital anomalies: a systemic review and meta-analysis of cohort studies.

To perform a meta-analysis of available cohort studies on the association between sertraline use by pregnant women in the first trimester and the findings of congenital anomalies in infants. A comprehensive search of articles published from the index date up to 31st December 2015 investigating the aforementioned associations was conducted on PubMed and Web of Science. Mesh headings used included the terms "serotonin reuptake inhibitor," "sertraline," "congenital anomalies" and "obstetrical outcome." Twelve cohort studies that involved 6 468 241 pregnant women were identified. We summarized odds ratios (ORs) and 95% confidence intervals (CIs) of congenital anomalies using the random-effects model. Pregnant women who used sertraline in the first trimester had a statistically significant increased risk of infant cardiovascular-related malformations (OR=1.36; 95% CI=1.06-1.74; I2 =64.4%; n=12) as well as atrial and/or ventricular septal defects (OR=1.36, 95% CI=1.06-1.76; I2 =62.2%; n=8). Additionally, positive but nonsignificant associations between sertraline use and congenital anomalies of the nervous system (OR=1.39; 95% CI=0.83-2.32; I2 =0%; n=5), digestive system (OR=1.23; 95% CI=0.76-1.98; I2 =0%; n=5), eye, ear, face and neck (OR=1.08; 95% CI=0.33-3.55; I2 =32.1%; n=3), urogenital system (OR=1.03; 95% CI=0.73-1.46; I2 =0%; n=5), and musculoskeletal system (OR=0.97; 95% CI=0.69-1.36; I2 =0%; n=5) were observed. This meta-analysis suggested that the use of sertraline use by pregnant women in the first trimester had an increased risk of cardiovascular-related malformations as well as atrial and/or ventricular septal defects in infants. Meanwhile, nonsignificant associations between sertraline use and other congenital anomalies were found. More cohort studies are warranted to provide detailed results of other congenital anomalies.

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.

Repair of Partial Atrioventricular Septal Defect in Infants: A Multi-Institutional Review

Repair of Partial Atrioventricular Septal Defect in Infants: A Multi-Institutional Review

50th Anniversary Landmark Commentary on Rein JG, Freed MD, Norwood WI, Castaneda AR. Early and Late Results of Closure of Ventricular Septal Defect in Infancy. Ann Thorac Surg 1977;24:19–27

50th Anniversary Landmark Commentary on Rein JG, Freed MD, Norwood WI, Castaneda AR. Early and Late Results of Closure of Ventricular Septal Defect in Infancy. Ann Thorac Surg 1977;24:19–27