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Objective: To compare surgical and device closure of isolated secundum atrial septal defect (ASD) in terms of hospital costs, clinical outcome, and impact on the patient and family., Design: Prospective, observational study., Setting: Paediatric tertiary referral centre., Patients: Consecutive local children with a secundum ASD, admitted between 1 May 1999 and 1 May 2001., Methods: Parents completed a standardised questionnaire at recruitment (on admission), at discharge, and one month after the procedure. Clinical and hospital generated cost data were collated at discharge., Results: 62 children were included in the analysis: 19 who underwent surgical repair and 43 who underwent device closure with the Amplatzer septal occluder. Median procedure times and hospital stay were significantly longer for surgical patients (170 (147 to 180) v 92 (70 to 115) minutes and 88 (78 to 112) v 29 (28 to 30) hours, respectively; p < 0.01). There was no difference in the complication rate. No device patients required intensive care or blood products. The median values for postoperative pain score, analgesia use, and convalescence time were greater for surgical patients. The median cost of each procedure was similar, but higher nursing and laboratory costs contributed to a slightly greater total cost for surgical repair (Aus$12 969 ($11 569 to $14 215) v Aus$11 845 ($10 669 to $12 555), p = 0.03)., Conclusions: Device closure of ASD involves a shorter hospital stay, causes less discomfort and familial disturbance, and carries less cost than surgical closure. However, there should be guarded acceptance of this technique until long term data are available.

Surgical treatment of various septal defects has been long established. With the advances in transcatheter therapy dilatation techniques for valvular stenosis and vascular obstruction have become established procedures. Closure of septal defects in the catheterization laboratory has also been introduced; some of these have come into regular use in current practice. In 1967, Porstmann et al reported the use of Ivalon plug to close patent ductus arteriosus (PDA). Since then, several devices have been used including Rashkind PDA ocluder (not being used now), Gianturco coils, detachable coils (for small PDA), CardioSEAL and other umbrella devices and Amplatzer PDA occluder. Closure rates vary from 95-98% in most series, however, some of these devices are very expensive, more so, when compared to the cost of surgical ligation of PDA. Catheter closure of secundum atrial septal defect (ASD) has also been done by various devices like clamshell device, Sideris Buttoned device, ASDOS device, Amplatzer device and cardioSEAL. So far no device has been accepted as ideal for every case, however, Amplatzer device has been used most extensively. Issues such as completeness of endothelialisation, incidence of late arrhythmias, endocarditis remain uncertain. However, in select population of ASD cases with a central secundum defect, device closure is being used increasingly. Device closure of ventricular septal defect remains challenging and controversial and is probably available to a small group of children with defects that are difficult to close surgically and involve higher risk.

Surgical treatment of various septal defects has been long established. With the advances in transcatheter therapy dilatation techniques for valular stenosis and vascular obstruction have become established procedures. Closure of septal defects in the catheterization laboratory has also been introduced; some of these have come into regular use in current practice. In 1967, Porstmann et al reported the use of Ivalon plug to close patent ductus arteriosus (PDA). Since then, several devices have been used including Rashkind PDA occluder (not being used now), Gianturco coils, detachable coils (for small PDA), CardioSEAL and other umbrella devices and Amplatzer PDA occluder. Closure rates vary from 95-98% in most series, however, some of these devices are very expensive, more so, when compared to the cost of surgical ligation of PDA. Catheter closure of secundum atrial septal defect (ASD) has also been done by various devices like clamshell device, Sideris Buttoned device, ASDOS device, Amplatzer device and cardioSEAL. So far no device has been accepted as ideal for every case, however, Amplatzer device has been used most extensively. Issues such as completeness of endothelialisation, incidence of late arrhythmias, endocarditis remain uncertain. However, in a select population of ASD cases with a central secundum defect, device closure is being used increasingly. Device closure of ventricular septal defect remains challenging and controversial and is probably available to a small group of children with defects that are difficult to close surgically and involve higher risk.

Closure of atrial septal defects be means of intravenous catheterisation has been undertaken using a variety of devices as an alternative to surgical closure. We describe the first case, to the best of our knowledge, of infective endocarditis complicating a successful transcatheter closure. This highlights the potential risk of this procedure, and emphasises the need for appropriate antibiotic prophylaxis until complete endothelialization of the device has occurred.

Device closure of oval fossa atrial septal defects with the Amplatzer Septal Occluder was performed in 26 patients ranging in age from 0.89 to 60.44 years. In eight additional patients no device implant was performed because of the presence of multiple defects or because the defect was of a size unsuitable for closure with the devices currently available. The stretched diameter of the defects that were closed ranged from 4 to 23 mm (mean 14+/-5.4 mm) and device sizes ranged from 4 to 24 mm. Two devices were unstable, of which one embolized to the right atrium after release. Both devices were retrieved at the same procedure. One of these patients subsequently underwent a successful device closure of his defect using a larger (24-mm) device. Three patients had multiple defects, which were successfully closed with a single device. At 1-month follow-up 23/26 (88%) and at 3-month follow-up 22/24 (92%) patients had complete closure of their defects, while two had residual shunts. One further patient who had complete closure of his defect at 1-month post-implant had his device removed and his atrial septal defect patched surgically 8 weeks after device closure. This was done as a result of the development of a vegetation affecting the device after an episode of septicaemia, which was not related to the cardiac problems. There was no procedure-related morbidity or mortality and all patients remain well at the present time.

A case of common atrium with anomalous systemic and pulmonary venous connections and pulmonary stenosis is described. Surgical correction was performed by pulmonary valvotomy and the insertion of an intra-atrial pericardial baffle. To our knowledge this is the first reported case of surgical correction of total anomalous connections of both systemic and pulmonary veins. The embryologic development of this condition is discussed.