Catheterization and Cardiovascular Interventions 00:00–00 (2014)
Original Studies Characteristics of Secundum Atrial Septal Defects Not Percutaneously Closed Naoki Ohno, MD, Rajiv Chaturvedi, MD, PhD, FRCPC, Kyong-Jin Lee, MD, FRCPC, and Lee Benson,* MD, FRCPC, FSCAI 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 5 124, mean age 5 5.7 years; range: 0.6–17.4 years; defect diameter/body weight 5 1.39) included: the need for a device thought too large for implantation versus the child’s size (n 5 51), defects with deficient rim(s) (n 5 48), multiple defects (n 5 7), defects sized >36 mm (n 5 2), malposition (n 5 2), ECG changes (n 5 3), aneurysmal IAS (n 5 2), sinus venosus (n 5 2), or others (n 5 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. VC 2014 Wiley Periodicals, Inc. Key words: congenital heart disease; pediatric cardiac catheterization; interventional cardiology
INTRODUCTION
Transcatheter closure of a secundum atrial septal defect (ASD) is widely accepted as an effective treatment alternative to traditional surgical closure. Numerous published series have documented that device closure has a high success rate, low incidence of complications and compares favorably to surgical closure [1–6]. On the other hand, some children are refered directly for surgical closure based on transthoracic echocardiographic (TTE) findings without attempting percutaneous closure or evaluated as unsuitable based on more invasive transesophageal (TEE) or intracardiac echocardiographic observations (ICE), catheterization with defect balloon sizing or during attempted catheter closure itself. The aim of this study was to review the our single center experience to characterize deferred device closure, evaluating incidence, morC 2014 Wiley Periodicals, Inc. V
phological characteristics, and rationale for which device closure was thought inappropriate. Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada Conflict of Interest: Nothing to report *Correspondence to: Lee Benson, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. E-mail: [email protected] Received 18 March 2014; Revision accepted 10 October 2014 DOI: 10.1002/ccd.25700 Published online 00 Month 2014 in Wiley Online Library (wileyonlinelibrary.com)
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Ohno et al.
for further evaluation of the defect and adequacy of surrounding septal rims was performed by balloon sizing [10]. A deficient rim was defined as
Original Studies Characteristics of Secundum Atrial Septal Defects Not Percutaneously Closed Naoki Ohno, MD, Rajiv Chaturvedi, MD, PhD, FRCPC, Kyong-Jin Lee, MD, FRCPC, and Lee Benson,* MD, FRCPC, FSCAI 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 5 124, mean age 5 5.7 years; range: 0.6–17.4 years; defect diameter/body weight 5 1.39) included: the need for a device thought too large for implantation versus the child’s size (n 5 51), defects with deficient rim(s) (n 5 48), multiple defects (n 5 7), defects sized >36 mm (n 5 2), malposition (n 5 2), ECG changes (n 5 3), aneurysmal IAS (n 5 2), sinus venosus (n 5 2), or others (n 5 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. VC 2014 Wiley Periodicals, Inc. Key words: congenital heart disease; pediatric cardiac catheterization; interventional cardiology
INTRODUCTION
Transcatheter closure of a secundum atrial septal defect (ASD) is widely accepted as an effective treatment alternative to traditional surgical closure. Numerous published series have documented that device closure has a high success rate, low incidence of complications and compares favorably to surgical closure [1–6]. On the other hand, some children are refered directly for surgical closure based on transthoracic echocardiographic (TTE) findings without attempting percutaneous closure or evaluated as unsuitable based on more invasive transesophageal (TEE) or intracardiac echocardiographic observations (ICE), catheterization with defect balloon sizing or during attempted catheter closure itself. The aim of this study was to review the our single center experience to characterize deferred device closure, evaluating incidence, morC 2014 Wiley Periodicals, Inc. V
phological characteristics, and rationale for which device closure was thought inappropriate. Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Centre, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada Conflict of Interest: Nothing to report *Correspondence to: Lee Benson, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. E-mail: [email protected] Received 18 March 2014; Revision accepted 10 October 2014 DOI: 10.1002/ccd.25700 Published online 00 Month 2014 in Wiley Online Library (wileyonlinelibrary.com)
2
Ohno et al.
for further evaluation of the defect and adequacy of surrounding septal rims was performed by balloon sizing [10]. A deficient rim was defined as
