Objectives: Some secundum atrial septal defects (ASD) warrant closure below 3 years due to heart failure or retarded growth. In the asymptomatic group, echo measure of ASD progressively increases with age. If ASD device closure is safe under 3 years, smaller devices can be utilized and device surface exposed in the atria is reduced.
Methods: ASD closed below 3 years in our institution were analyzed. Surgery was offered only if the margins were totally absent. Patients with even deficient margins had attempted device closure after informed consent. Device size was equal to the largest ASD echo measurement; no balloon sizing was done. Surgery on cardiopulmonary bypass was done through sternotomy or thoracotomy.
Results: Among 21 patients aged 2.1 +/- 0.7 years, weighing 10.1 +/- 2.4 kg with ASD measuring 16.6 +/- 4.2mm, 14 weighed below tenth centile, 2 had heart failure, rest were asymptomatic. 16 patients had attempted device closure with device size of 17 +/- 4.6mm. In one patient weighing 8 kg with 16 mm ASD, catheter injury to right pulmonary vein caused hemothorax, needing surgery. Device closure was uncomplicated and successful in others. 5 patients with absent margins electively operated also had uncomplicated outcome. The mean duration of hospital and intensive stay was anticipatedly longer after surgery. There were no procedural deaths.
Conclusions: Three fourths of ASD needing closure will be amenable anatomically for device closure. In patients below 3 years, device closure is safe and feasible. Due procedural care should be exercised to avoid procedural complications.