Cardiology in the Young



Original Article

A comparison between the early and mid-term results of surgical as opposed to percutaneous closure of defects in the oval fossa in children aged less than 6 years


Gianfranco Butera a1c1, Mariella Lucente a1, Luca Rosti a1, Massimo Chessa a1, Angelo Micheletti a1, Alessandro Giamberti a1, Luciane Piazza a1, Raul Abella a1, Alessandro Frigiola a1 and Mario Carminati a1
a1 Department of Pediatric Cardiology and Cardiac Surgery, San Donato Milanese Hospital, Italy

Article author query
butera g   [PubMed][Google Scholar] 
lucente m   [PubMed][Google Scholar] 
rosti l   [PubMed][Google Scholar] 
chessa m   [PubMed][Google Scholar] 
micheletti a   [PubMed][Google Scholar] 
giamberti a   [PubMed][Google Scholar] 
piazza l   [PubMed][Google Scholar] 
abella r   [PubMed][Google Scholar] 
frigiola a   [PubMed][Google Scholar] 
carminati m   [PubMed][Google Scholar] 

Abstract

Objectives: To compare surgical as opposed to percutaneous interventional closure of isolated atrial septal defects in the oval fossa in terms of hospital stay, efficacy, and complications, and to study the respective role of the two techniques in current practice. Methods: Between January 1998 and April 2004, 126 out of 1210 patients treated at our institution for closure of an isolated defect in the oval fossa were aged less than 6 years. The mean age of these 126 patients at procedure was 4.2 plus or minus 1 year. The ratio of females to males was 74 to 52. Results: Of the patients, 62% were treated successfully using a percutaneous approach. The groups treated surgically or percutaneously did not differ for age, gender, or indications for treatment. No deaths occurred. The rates of total and major complications were higher in the group undergoing surgical closure, at 34% versus 9%, p less than 0.0001, and 10.5% versus 1%, p equal to 0.01, respectively. Embolisation of the device requiring subsequent surgery occurred in 1% of patients. The stay in hospital was shorter in those closed percutaneously, at 3.2 plus or minus 0.9 days versus 6.8 plus or minus 2.8 days, p equal to 0.0001. During a mean follow-up of 3.4 plus or minus 1.9 years, no major complications occurred in either group, and symptoms improved significantly in both groups. Additional sequels occurred in 2 patients who had major complications subsequent to surgical closure. Conclusions: Even in young children, it is both feasible and safe to close defects in the oval fossa percutaneously. Compared to surgical closure, the transcatheter approach allows a shorter stay in hospital, and has a lower rate of complications. Early and mid-term follow-up has confirmed the safety and efficacy of both techniques.

(Accepted March 1 2006)


Key Words: Interventional cardiology; congenital heart disease; secundum atrial septal defect.

Correspondence:
c1 Correspondence to: Dr Gianfranco Butera, Department of Pediatric Cardiology, San Donato Milanese Hospital, Via Morandi, 30, 20097 San Donato Milanese, Italy. Tel: +39 2 5277 4328; Fax: +39 2 5277 4459; E-mail: gianfra.but@lycos.com