Cardiology in the Young

Table of Contents - 2001 - Volume 11, Issue 05  


Original Article

Influence of the introduction of Amplatzer device on the interventional closure of defects within the oval fossa in children

Mahvash Rastegari a1a2, Andrew N. Redington a1a2 and Ian D. Sullivan a1a2c1
a1 Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London
a2 The Institute of Child Health, London, UK

Article author query
rastegari m   [PubMed][Google Scholar] 
redington an   [PubMed][Google Scholar] 
sullivan id   [PubMed][Google Scholar] 

Abstract

Since June 1998, we have used an Amplatzer device whenever considered appropriate in patients with isolated defects within the oval fossa. The aim of this study was to define the total cohort of patients with isolated defects in the oval fossa seen at this hospital, so as to assess the impact of this policy on contemporary management. In the two-year period commencing 1st June 1998, 116 patients older than 6 months were seen with an isolated septal defect within the oval fossa. Mean age at closure or last review was 5.8 years, with a range from 0.5 to 20 years. In total, 42 (36%) patients were assigned to surgical closure, 25 (22%) to closure using an Amplatzer device, and 49 (42%) remained under clinical follow up. Direct referral for surgical closure occurred in 24 (21%) patients, in whom transcatheter closure was considered not appropriate after transthoracic echocardiography. Transoesophageal echocardiography was performed in 45 (39%) patients to assess suitability for closure using the Amplatzer device. Of these, 20 (44% of the group undergoing transoesophageal echocardiography) were considered unsuitable for closure in this fashion. Of these, 8 were referred for surgery and 2 with small defects were considered not to require closure. Patients undergoing closure with the device were older than the group referred for surgical closure, having a median age of 7.8 versus 3.6 years, and stayed for a shorter period in hospital. Those closed using the device stayed for 2 days, as opposed to a median of 5 days, with a range from 4 to 10 days for those undergoing surgical closure. Closure was complete as assessed by echocardiography after follow up of 1–3 months in both groups. There were no recognised complications related to insertion of the device, whereas transient postoperative morbidity occurred in 38% of those closed surgically. Insertion of an Amplatzer device was considered to be appropriate in 37% of patients older than 6 months requiring closure of an atrial septal defect in the oval fossa.

(Published Online August 15 2006)
(Accepted April 6 2001)


Key Words: Secundum atrial septal defect; interventional catheterisation; surgery.

Correspondence:
c1 Correspondence to: Dr Ian Sullivan, Consultant in Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK. Tel: +44 207 829 8845; Fax: +44 207 829 8673.

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