Premium
Characteristics of secundum atrial septal defects not percutaneously closed
Author(s) -
Ohno Naoki,
Chaturvedi Rajiv,
Lee KyongJin,
Benson Lee
Publication year - 2014
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25700
Subject(s) - septum secundum , medicine , cardiac catheterization , percutaneous , closure (psychology) , intracardiac injection , heart septal defect , surgery , demographics , cardiology , foramen secundum , patent foramen ovale , market economy , demography , sociology , economics
Objectives We sought to review our single center experience with secundum atrial septal defect (ASD) device closure, evaluating the incidence and morphological characteristics where percutaneous closure was thought inappropriate. Material and methods All children assessed as unsuitable for transcatheter device closure were reviewed. Data collected included: demographics, defect morphology by echocardiogrphy or at cardiac catheterization and defect size focusing on the reasons for procedural deferral. Results Between January 2002 and December 2010, 639 children underwent closure of an isolated secundum ASD: 82 children (13%) where referred directly to surgery, 43 (6%) were thought unsuitable for device closure at the time of catheterization and underwent subsequent surgery and the remaining 514 (81%) underwent successful device closure including 2 on a second attempt. The reasons for pursuing a surgical closure ( n = 124, mean age = 5.7 years; range: 0.6–17.4 years; defect diameter/body weight = 1.39) included: the need for a device thought too large for implantation versus the child's size ( n = 51), defects with deficient rim(s) ( n = 48), multiple defects ( n = 7), defects sized >36 mm ( n = 2), malposition ( n = 2), ECG changes ( n = 3), aneurysmal IAS ( n = 2), sinus venosus ( n = 2), or others ( n = 7). Conclusion The reasons for deferring transcatheter device closure of a secundum ASD are diverse, not only isolated rim deficiencies but the requirements of large implants, malposition, arrhythmias, and lack of hemodynamic need are influential components in clinical decision making. © 2014 Wiley Periodicals, Inc.