Catheter-Based Closure of Atrial Septal Defects in the Oval Fossa With the Amplatzer® Device in Patients in Their First or Second Year of Life

Objective: To assess feasibility, safety, and efficacy of the use of Amplatzer (R) occluders in closure of atrial septal defects (ASD) in children in the first 2 years of life. Background: Although scattered reports on such closure have been published, no agreement consists on the policy. Methods: In 654 patients of all ages, closure was achieved in 632 (96.6%). Data were analyzed retrospectively in all 71 children where an attempt had been made to close the ASD before their second birthday. Results: Median age and body weight were 17.2 months (range 3.9-23.8) and 10.0 kg (range 3.8-14.5), respectively. Median fluoroscopy time was 13.6 min and median device size 15 mm. Successful closure was achieved in 68 children (95.8%). Three times the procedure was aborted: in one, the device repeatedly straddled the septum; in the other two, a small left atrium restricted the movement of the left-sided disc. One device embolized and was reimplanted after retrieval. One infant with multiple disorders died 6 days after closure from acute sepsis probably unrelated to the procedure. No other complications occurred. Only trivial shunts closing with time were registered during follow-up. Symptomatic patients profited markedly from closure. Conclusion: The results and complications of ASD closure with the Amplatzer (R) device in patients in their first 2 years of life compare favorably with procedures in older patients, provided that the size of the septum and the dimensions in the left atrium are taken into consideration when selecting the size of the device. (C) 2009 Wiley-Liss, Inc.