From the Guidelines
The recommended treatment for a 6-year-old with an atrial septal defect (ASD) is transcatheter closure for secundum ASDs with adequate rims, or surgical repair for primum ASDs, sinus venosus defects, or very large secundum ASDs. The choice of treatment depends on the defect size, location, and the child's overall health. For small ASDs (less than 8mm) that are expected to close on their own, watchful waiting with regular cardiology follow-up may be appropriate 1. However, for moderate to large ASDs, closure is generally recommended to prevent long-term complications such as pulmonary hypertension, arrhythmias, and heart failure 1.
Key Considerations
- Transcatheter closure is a minimally invasive procedure that typically requires only an overnight hospital stay with return to normal activities within a week 1.
- Surgical repair under cardiopulmonary bypass is necessary for primum ASDs, sinus venosus defects, or very large secundum ASDs, requiring a 3-5 day hospital stay and 4-6 weeks for full recovery 1.
- Prior to either procedure, the child may need antibiotic prophylaxis for dental procedures, and following closure, antiplatelet therapy with low-dose aspirin (3-5 mg/kg/day, maximum 81 mg) is typically prescribed for 6 months 1.
- The goal of treatment is to prevent right heart enlargement and the development of irreversible pulmonary hypertension that can occur if large ASDs are left untreated 1.
Treatment Options
- Transcatheter closure using devices such as the AMPLATZER septal occluder or HELEX septal occluder is a preferred method for secundum ASDs with adequate rims 1.
- Surgical repair is necessary for primum ASDs, sinus venosus defects, or very large secundum ASDs 1.
- Watchful waiting with regular cardiology follow-up may be appropriate for small ASDs (less than 8mm) that are expected to close on their own 1.
From the Research
Treatment Options for Atrial Septal Defect (ASD) in a 6-Year-Old
The recommended treatment for a 6-year-old with an atrial septal defect (ASD) typically involves closure of the defect, which can be achieved through either surgical or transcatheter methods.
- Surgical Closure: This method involves open-heart surgery to close the defect. It is often recommended for larger defects or those with complex anatomy 2.
- Transcatheter Closure: This is a minimally invasive procedure where a device is inserted through a catheter to close the defect. It has been shown to have fewer complications, shorter hospitalization, and reduced need for blood products compared to surgical closure 2.
Considerations for Treatment
When deciding on the treatment approach, several factors are considered, including:
- Defect Size and Location: The size and location of the ASD can influence the choice between surgical and transcatheter closure 2.
- Age and Weight of the Child: While ASDs are typically asymptomatic in infancy and early childhood, elective defect closure is usually performed at ages of 4 to 6 years 3. For younger children, especially those with symptoms or complications, earlier intervention may be necessary 4, 5.
- Presence of Other Health Conditions: Children with concomitant conditions, such as prematurity with bronchopulmonary dysplasia or elevated pulmonary artery pressures, may benefit from earlier closure to improve clinical outcomes 4.
Outcomes and Benefits of Treatment
- Improved Symptoms: Closure of the ASD can lead to significant improvement in symptoms, particularly in children with chronic lung disease 4.
- Reduced Risk of Complications: Closing the ASD can reduce the risk of future complications, such as arrhythmic events and paradoxical emboli 6.
- Excellent Midterm Outcomes: Studies have shown excellent midterm outcomes in children who undergo ASD closure, with normalization of pulmonary pressures and improvement in clinical status 3, 4.