Early Surgical Closure of Atrial Septal Defect Improves Clinical Status of Symptomatic Young Children with Underlying Pulmonary Abnormalities

Tsuda T, Davies RR, Radtke W, Pizarro C, Bhat AM.Pediatr Cardiol. 2020 May 9:1-10. doi: 10.1007/s00246-020-02361-8. Online ahead of print.PMID: 32388668 Free PMC article.



Elective closure of atrial septal defect (ASD) is usually recommended during preschool ages. However, ASD may contribute to deteriorating health in the presence of significant comorbidity and, thus, may need earlier closure. There is a lack of clarity regarding the indications for and outcomes after ASD closure in infancy and early childhood. We investigated the benefits and safety of surgical ASD closure in symptomatic patients under 2 years of age. Retrospective chart review was conducted in patients who underwent surgical ASD closure within the first 2 years of life. Of 31 symptomatic ASD patients, 22 had persistent respiratory symptoms, 24 failure to thrive, and 9 pulmonary hypertension. Overall, 26 patients (84.0%) showed clinical improvement after ASD closure, including improved respiratory status (17/22; 77.3%), resumption of normal growth (15/24; 62.5%), and resolution of pulmonary hypertension (7/7; 100%, 2 patients unable to assess postoperatively). Two medically complicated patients died a few months after surgery unrelated to surgical complications. Four out of 8 ventilator-dependent patients were weaned from mechanical ventilation within 1 month after ASD closure. Closure of ASD did not improve those patients with highly advanced lung disease and/or medically complex conditions including underlying genetic abnormalities. Surgical complications were uncommon. Postoperative hospital stay was 4 to 298 days (median 8 days). The majority of our patients demonstrated significant clinical improvement after ASD closure. Early ASD closure is safe and beneficial for symptomatic infants and young children with associated underlying pulmonary abnormalities, especially bronchopulmonary dysplasia.


Fig. 1 a Resumption of normal physical growth after ASD closure. Y axis represents z score of body weight at standard growth chart (CDC 0 to 36 months, male or female). Positive trend was noted in 15 patients (left; z score from − 3.8 ± 1.2 to − 0.9 ± 1.6: p < 0.00005), whereas there was no improvement in 7 patients (right; z score from − 2.9 ± 1.3 to − 2.7 ± 1.6). One patient in the nonresponsive group was not included because the patient died 3 months after ASD closure (Pt 15). b Improvement of pulmonary hypertension (PH) after ASD closure. Y axis represents pressure gradient (mmHg) of tricuspid regurgitation (TR) jet assessed by continuous pulse Doppler method before and after ASD closure. Postoperative echocardiogram was performed within 6 months after surgery. All 7 patients showed significant decrease in TR pressure gradient (62.8 ± 14.8 to 29 ± 7.0 mmHg; p < 0.005)