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

Since June 1998, we have used an Amplatzer device whenever considered appro priate 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 thi s policy on contemporary management. In the two-year period commencing Ist June 1998, 116 patients older than 6 months were seen with an isolated sept al 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 devic e, and 49 (42%) remained under clinical follow up. Direct referral for surg ical closure occurred in 24 (21%) patients, in whom transcatheter closure w as considered not appropriate after transthoracic echocardiography. Transoe sophageal echocardiography was performed in 45 (39%) patients to assess sui tability for closure using the Amplatzer device. Of these, 20 (44% of the g roup undergoing transoesophageal echocardiography) were considered unsuitab le for closure in this fashion. Of these, IS were referred for surgery and 2 with small defects were considered not to require closure. Patients under going closure with the device were older than the group referred for surgic al closure, having a median age of 7.8 versus 3.6 years, and stayed for a s horter 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 echocardi ography after follow up of 1-3 months in both groups. There were no recogni sed complications related to insertion of the device, whereas transient pos toperative 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 ov al fossa.