Background:Percutaneous atrial septal defect (ASD) closure is the treatment of choice for patients with a suitable ASD anatomy; however, the procedural characteristics and outcomes in children aged <6 years are unclear. The feasibility and safety of percutaneous ASD closure in children aged <6 years was evaluated and the predictors of procedural failure and challenging cases were identified.

Methods and Results:Patients from a single center between 2006 and 2018 (n=407) were retrospectively evaluated. There were 265 (65.1%) female patients. The median age at the time of the procedure and ASD size were 3.4 (0.9–5.9) years and 13.3 (3.8–27.0) mm, respectively. Medical records and echocardiographic images were analyzed. A challenging case was indicated by the use of non-conventional techniques. The procedure was completed in 399 patients (98.0%). Post-procedural acute complications occurred in 5 patients, including 1 with device embolization. Two patients underwent surgical device removal. During the follow up (30.3 [3.6–140.8] months), aggravated mitral regurgitation occurred in 5 patients. A multivariate logistic regression revealed large-sized ASD as a predictor of procedural failure (odds ratio=1.828, 95% confidence interval: 1.139–2.934, P=0.012) and challenging cases (odds ratio=1.371, 95% confidence interval: 1.180–1.593, P<0.001).

Conclusions:Percutaneous ASD closure is feasible and safe in children aged <6 years; however, patients with large-sized ASD are at high risk of procedural failure and becoming a challenging case.

背景：经皮房间隔缺损 (ASD) 封堵术是适合 ASD 解剖结构的患者的首选治疗方法。然而，6 岁以下儿童的程序特征和结果尚不清楚。评估了 6 岁以下儿童经皮 ASD 闭合术的可行性和安全性，并确定了手术失败和具有挑战性的病例的预测因素。

方法和结果：回顾性评估了 2006 年至 2018 年间来自单一中心的患者（n=407）。有 265 名 (65.1%) 女性患者。手术时的中位年龄和 ASD 大小分别为 3.4 (0.9-5.9) 岁和 13.3 (3.8-27.0) mm。分析医疗记录和超声心动图图像。使用非常规技术表明了一个具有挑战性的案例。399 名患者 (98.0%) 完成了手术。5例患者出现术后急性并发症，其中1例为装置栓塞。两名患者接受了手术装置移除。在随访期间（30.3 [3.6-140.8] 个月），5 名患者出现二尖瓣反流加重。多变量逻辑回归显示大尺寸 ASD 作为程序失败的预测因子（优势比 = 1.828，95% 置信区间：1.139-2.934，P = 0。

结论： <6岁儿童经皮ASD封堵术是可行且安全的；然而，大面积 ASD 患者手术失败的风险很高，并成为一个具有挑战性的病例。