Update on shunt closure in neonates and infants

ABSTRACT

Introduction: Cardiac defects that result in shunting are the most common types of congenital heart anomalies. Although these lesions can be simple, they can cause significant hemodynamic changes and can be challenging to manage in neonates and infants. Over the recent decades, the development of new transcatheter techniques and devices has made it safe and feasible to manage such defects when indicated, even in the smallest of patients. Understanding these interventional procedures is essential in order to manage those patients.

Areas covered: In this article, we review the techniques and experience for closure of atrial septal defects, ventricular septal defects, patent ductus aarteriosus,as well as coronary arteriovenous malformations and fistulas in neonates and infants. Literature review of PubMed articles was performed through January 2021, with focus on the latest data and results of the usage of interventional techniques in treating these lesions specifically in this age-group.

Expert opinion: Significant shunting lesions can be particularly challenging to manage in neonates and infants. Newer lower profile devices will likely continue to be developed in the future, allowing their use for transcatheter interventions in even smaller patients and those with more complex anatomy.

KEYWORDS:

• Shunt closure
• percutaneous closure
• infants
• septal defects
• coronary fistulas
• transcatheter interventions

 

Article highlights

• Cardiac shunting lesions are the most common congenital heart malformations and include ASD, VSD, PDA and coronary arteriovenous malformations

• Shunting lesions can present with significant symptoms of heart failure, pulmonary hypertension and worsening need for ventilator support, necessitating early intervention even in infants and premature neonates

• Percutaneous and hybrid approaches to device closure of cardiac shunting lesions are becoming safer and more feasible even in neonates and infants

• Various lower profile devices are available for use in smaller infants for closure of ASD, VSD, PDA as well as coronary artery fistulas with age and weight becoming less of a limiting factor to these procedures

• While surgical closure of shunting lesions has a low perioperative mortality and morbidity, it is still associated with significant risks especially in high-risk infants.

• In addition to the percutaneous approach, the peratrial and perventricular hybrid approaches offer an adjunct to surgery in specific patients

• PDA device closure is becoming more feasible with the newer devices even in small neonates <1 kg

• CAF can be closed percutaneously even in infants, when they have the appropriate anatomy

Declaration of interest

DDrZ. Hijazi is a consultant for Occlutech. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.