Trans-Catheter Device Closure of Atrial Septal Defect in Symptomatic Children Up to 10 Kg of Body Weight: A Multicentric Retrospective Observational Cohort Study to Assess Feasibility, Safety and Midterm Results After Closure

Background: Atrial septal defect (ASD) is the second most prevalent congenital heart diseases (CHD) encompassing 8-10% of all CHDs beyond neonatal period. Although relatively benign, if left untreated can amount to several adverse outcomes. Trans-catheter Device closure of ASD is a preferred therapy for a hemodynamically significant shunt. Despite multitude of septal occluders being available these days, paucity of literature concerning appropriateness of device sizing, and various adaptations of techniques for device deployment in large ASDs with deficient rims and their outcomes in children up to 10 kg weight nevertheless still exists. Aims and Methods: A retrospective multi-centric observational study, was conducted in a cohort of children who underwent ASD device closure weighing up to 10 kg conducted over a period of 4 years, to assess its safety and feasibility. Results: Of the included 85 patients, 63% were females and 37% were males with mean age at intervention being 32 months. The mean weight and height were 9.17 Kg and 88 cm respectively. Mean of maximum ASD dimension was 14.92mm. Hemodynamic assessment with invasive PA pressures recordings suggested normal PA pressure in 82%, while 18% had pulmonary arterial hypertension. Mean Qp/Qs and PVR was 2.58 and 1.8 Wood units respectively. Average device: weight ratio was 1.9. Arrhythmias occurred in 6 children, five had Adenosine sensitive SVTs and one had persisting CHB necessitating surgical device retrieval and Permanent pacemaker implantation. No mortality occurred in this study. Conclusion: Trans-catheter closure of ASD is indeed safe and effective procedure if performed in children weighing up to 10 Kg, in a hemodynamically significant shunt, adopting modified techniques, even in presence of flimsy or deficient rims with device weight ratio up to 3:1