Work

Transcatheter atrial septal defect closure in infants weighing 3 to 6 kg with clinically significant bronchopulmonary dysplasia

Year: 2026

Type: article

Abstract: Video clip is available online.Atrial septal defects (ASDs) are the second most prevalent congenital heart defect in the United States. 1 In the modern era, there is increasing ease of diagnosis given improved diagnostic modalities.Canonical thinking suggests that many patients will remain asymptomatic until the second decade of life.However, with the increasingly successful neonatal resuscitation of extremely low birth weight infants at gestational ages <23 weeks, some premature infants experience excess pulmonary blood flow, pulmonary edema, and right heart dilation earlier than expected.2 This is especially of concern in premature infants with bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD) in which excess pulmonary blood flow may exacerbate pulmonary dysfunction and increase the already elevated risk for pulmonary vascular disease.Historically, an ideal candidate for transcatheter ASD closure had weight >15 kg. 3 Despite this prior patient selection parameter, there have been many reports of successful transcatheter ASD closure in infants with weight<10 kg with subsequent improvement in pulmonary function and a decrease in the respiratory support requirement.3-5,E1 We present a series of 7 infants weighing 3.3 to 6 kg across 4 centers who underwent successful transcatheter ASD closure using the Occlutech ASD Occluder. CASE SERIES SUMMARYSeven premature infants with BPD underwent transcatheter ASD closure using the Occlutech ASD Occluder device.The requirement for written informed consent for the use and publication of patient data was waived by the respective institutional review boards.Institutional review board approval was not required.Baseline characteristics, procedural details, and clinical outcomes are described in Tables 1 and 2. Median gestational age at birth was 24 weeks (range, 23-29 weeks), median chronological age at intervention was 4 months (range, 4-6 months), and median weight was 4.2 kg (range, 3.3-6.1 kg).Five patients had severe BPD, 1 had moderate-to-severe BPD, and 1 had moderate BPD.The median ratio of pulmonary to systemic blood flow assessed at the time of catheterization was 1.4:1 (range, 1.2:1-2.1:1),and median indexed pulmonary vascular resistance (PVRi) was 3.4 WU/m 2 (range, 1.82-3.62WU/m 2 ).There were no other pertinent congenital cardiac lesions in these cases.All patients were referred for ASD closure due to persistent respiratory morbidity attributed to a combination of

Source: JTCVS structural and endovascular.

DOI: 10.1016/j.xjse.2026.100151

Authors: Ernesto Mejia, Anne C. Taylor, Martin L. Bocks, Darren P. Berman