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Even though several devices have been developed to facilitate occlusion of cardio vascular structures in adults, only a few types of plugs have been approved in selected pediatric indications. However, apart from patent ductus arteriosus (PDA) closure, little data has been published in children, particularly with regard to the heterogeneity of the procedures and outcomes. To describe the efficacy, safety, and characteristics of the utilization of the Amplatzer Vascular Plug (AVP) II and IV for cardiovascular percutaneous occlusions in children under 10 years. Retrospective multicenter (2006–2020, 6 academic centers) observational review of pediatric transcatheter occlusions using AVP II or IV. A total of 125 consecutive children (60 < 1 year, 145 lesions) underwent 136 successive procedures using 175 different devices (112 AVP IV, 63 AVP II) with a success rate of 98.5%. The mean device diameter was 7.7 ± 3.2 mm (4–20 mm). The median age and weight at implantation were 1.0 year (0.01–9.98 years) and 9.1 kg (1–69 kg), respectively. Procedures involved 55 PDA, 28 arterial bronchial or aorto-pulmonary collaterals, 18 sequestrations or Scimitar syndrome, 16 arteriovenous or veinovenous fistulae, 6 coronary fistulae, 6 vertical veins, 6 conduits, 5 ventricular septal defect, and 7 miscellaneous occlusions. The occlusion rate at Day1 was 96.3% and 100%, 6 months after, without hemolysis. Major adverse events (MAE) occurred in 5.1% mainly the need for surgery, without any related death. MAE was related to a lower weight (P = 0.04), a younger age (P = 0.02) and large PDA closure using AVP II (P < 0.01). AVP II and IV are safe and effective for the percutaneous treatment of numerous cardiovascular lesions in children under ten. In our multicenter experience, such devices represent a real "off-label" pediatric alternative in well-selected patients. [ABSTRACT FROM AUTHOR]

Our objective was to determine influence of age, body size, and gender on SAECG signals and to establish normal range for standard SAECG parameters in the pediatric population. Five hundred thirty healthy children and adolescents (290 males, 240 females) aged 6.0–17.3 years were studied with high resolution ECG. Patients were divided into five age groups, and each age group was divided in two subgroups according to gender. Parameters studied were filtered ORS duration, root mean square (RMS) voltage of the last 40 ms and of the last 30 ms of the filtered QRS complex, and duration of the terminal waveform of the filtered QRS < 40 μV of amplitude (LAS). After validation of the distribution of the various variables, means, standard deviations, and 95% confidence intervals were determined for each SAECG parameter at 25- to 250-Hz filtering and at 40- to 250-Hz filtering for the ten subgroups. There was a significant age and body surface area (BSA)-associated increase in filtered QRS duration in boys and girls, and a decrease in RMS voltage of the end of the ORS complex in girls. In addition, girls had a significantly shorter ORS and longer LAS durations than boys. These differences of signal-averaged signals between genders were not related to age or body size differences since analysis of covariance with age at evaluation or BSA as covariates showed the same trend. Three children (0.6%) had a SAECG out of normal range for age for the four parameters studied either at 25- or 40-Hz high pass filter. Due to the large sample studied, our results provide a basis for interpretation of SAECG in children. Normal ranges for the various variables were determined, and it appeared that adjustments for age, body size, and gender are mandatory when studying SAECG in children. [ABSTRACT FROM AUTHOR]

Neurodevelopmental disorders (NDD) are the most common, and potentially the most damaging sequelae in children with congenital heart disease (CHD) [1]. All areas could be affected impacting social adaptation, academic achievements, and quality of personal and family life even in adulthood. In our region, there is currently no specific additional follow-up for children with CHD. The objective was to assess the frequency of NDD in children with « significant » CHD (mild and moderate operated CHD, severe CHD), associated factors and frequency of follow-up in developmental therapies. This is a prospective observational study on children with significant CHD aged from 6 to 66 months conducted over a period of 6 months. Ages & Stages Questionnaire in French, Third Edition (ASQ-3) was used to screen neurodevelopmental domains. NDD were defined as cut-off scoring ≤ 1 SD below the normative mean. – 1 SD corresponding to «Monitor» range: children with minor or emerging disorders; – 2 SD corresponding to «Refer» range: children exhibiting neurodevelopemental delays. Socio-medico-surgical data were collected to assess associated factors and follow-up in developmental care services. Among the 210 included children, the rate of NDD was 60,0% (n = 126, 95%CI(53.4 - 66.6)). 40 children were in «Monitor» range, and 86 in «Refer» range. There was no difference regarding the severity of CHD (P = 0.99). Only presence of comorbidities (OR = 2.1; 95%CI(1.1 - 4.2); P = 0.02) was a significant associated factor of NDD in multivariate backward logistic regression analysis. 46 children with NDD had no follow-up in developmental services (among them 21 were in «Refer» range) despite provision of pathway of care for children with NDD. Children with CHD are at risk for NDD regardless of the severity of the CHD. Systematic and early monitoring in a specific program of care is necessary for all children with CHD for a better long-term prognosis. [ABSTRACT FROM AUTHOR]

Background Atrial septal defects (ASDs) can be symptomatic in small children in cases of co-morbidities. Transcatheter closure remains controversial for large defects in small children. Objective To describe transcatheter closure of ASDs in children with device/weight ratio ≥1.5. Methods We retrospectively studied between January 2000 and January 2016 all cases of percutaneous ASD closure with device/weight ratio ≥1.5 in 6 European centres. Results Forty patients were included with female/male ratio of 1.2. Median age and weight were 30.9 months (4.1–102.0) and 11.0 kg respectively (3.8–19.0). Median device size/weight ratio was 1.7 (1.5–2.3). All patients were symptomatic, with pulmonary hypertension in 13 (33%). Procedures were performed under general anesthesia or light sedation (n = 4), with transthoracic (n = 25) or transesophageal echocardiography (n = 15) guidance. Balloon stretched diameter (n = 32) was larger than the echocardiographic diameter (19 versus 15 mm, R = 0.6; p < 0.001). Deficient rims other than the anterior-superior one were found in 33% of cases. Device implantation was successful in 39 patients (97.5%). Minor complications occurred in 10% of cases, whereas severe complications rate was 5%: Complete atrioventricular block in one patient that resolved after surgical extraction of the device and thrombosis in the inferior vena cava in one patient. During a median follow-up of 52 months, there was no residual shunt. No case of erosion or embolization was reported and pulmonary hypertension resolved in all patients. Conclusion Percutaneous closure of large ASD in small and symptomatic children is feasible and allows clinical improvement with acceptable rate of complications in high risk population. [ABSTRACT FROM AUTHOR]