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

Vincent C. Thomas, Robert Vincent, Anthony Raviele, Helen Diehl, Holly Qian, Dennis Kim

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective. 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. Design. 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. Results. The patient ages ranged from 3-11 months (median 7) with weight ranges of 2.9-8.3kg (median 6.5). Defect sizes ranged from 5-15mm (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 55mmHg (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. Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)204-211
Number of pages8
JournalCongenital Heart Disease
Volume7
Issue number3
DOIs
StatePublished - May 1 2012

Fingerprint

Atrial Heart Septal Defects
Lung Diseases
Chronic Disease
Equipment and Supplies
Pressure
Pulmonary Artery
Bronchopulmonary Dysplasia
Lung
Patient Rights
Premature Infants
Respiratory Insufficiency
Parents
Interviews
Pediatrics
Oxygen
Weights and Measures

Keywords

  • Atrial septal defect
  • Chronic lung disease
  • Prematurity
  • Transcatheter

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter Closure of Secundum Atrial Septal Defect in Infants Less than 12 Months of Age Improves Symptoms of Chronic Lung Disease. / Thomas, Vincent C.; Vincent, Robert; Raviele, Anthony; Diehl, Helen; Qian, Holly; Kim, Dennis.

In: Congenital Heart Disease, Vol. 7, No. 3, 01.05.2012, p. 204-211.

Research output: Contribution to journalArticle

Thomas, Vincent C. ; Vincent, Robert ; Raviele, Anthony ; Diehl, Helen ; Qian, Holly ; Kim, Dennis. / Transcatheter Closure of Secundum Atrial Septal Defect in Infants Less than 12 Months of Age Improves Symptoms of Chronic Lung Disease. In: Congenital Heart Disease. 2012 ; Vol. 7, No. 3. pp. 204-211.
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abstract = "Objective. 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. Design. 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. Results. The patient ages ranged from 3-11 months (median 7) with weight ranges of 2.9-8.3kg (median 6.5). Defect sizes ranged from 5-15mm (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 55mmHg (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. Conclusion. 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.",
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AB - Objective. 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. Design. 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. Results. The patient ages ranged from 3-11 months (median 7) with weight ranges of 2.9-8.3kg (median 6.5). Defect sizes ranged from 5-15mm (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 55mmHg (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. Conclusion. 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.

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