P ERCUTANEOUS CLOSURE OF DEFECTS IN THE oval fossa has gained increasing acceptance since introduction of the latest generation of devices. The Amplatzer device is now most fre- quently used in contemporary clinical practice, and short-term results have been good. 1–5 Studies to date have reported the results of the procedures per- formed during implantation rather than describing protocols based on the intention to treat, although there has been one report comparing results and complications after surgical closure as opposed to insertion of an Amplatzer device. 6 Previous studies have included many, or predomi- nantly, adults. Data are lacking regarding the propor- tion of children requiring closure who are suitable for insertion of an Amplatzer device. The number of patients investigated by transoesophageal echocar- diography, cardiac catheterisation, or both, which are Cardiol Young 2001; 11: 521–525 © Greenwich Medical Media Ltd. ISSN 1047-9511 Original Article Influence of the introduction of Amplatzer device on the interventional closure of defects within the oval fossa in children Mahvash Rastegari, Andrew N. Redington, Ian D. Sullivan Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London; The Institute of Child Health, London, UK Abstract Since June 1998, we have used an Amplatzer device whenever considered appropriate in patients with isolated defects within the oval fossa. The aim of this study was to define the total cohort of patients with iso- lated defects in the oval fossa seen at this hospital, so as to assess the impact of this policy on contemporary man- agement. In the two-year period commencing 1st June 1998, 116 patients older than 6 months were seen with an isolated septal defect within the oval fossa. Mean age at closure or last review was 5.8 years, with a range from 0.5 to 20 years. In total, 42 (36%) patients were assigned to surgical closure, 25 (22%) to closure using an Amplatzer device, and 49 (42%) remained under clinical follow up. Direct referral for surgical closure occurred in 24 (21%) patients, in whom transcatheter closure was considered not appropriate after transthoracic echocardiography. Transoesophageal echocardiography was performed in 45 (39%) patients to assess suitability for closure using the Amplatzer device. Of these, 20 (44% of the group undergoing transoesophageal echo- cardiography) were considered unsuitable for closure in this fashion. Of these, 8 were referred for surgery and 2 with small defects were considered not to require closure. Patients undergoing closure with the device were older than the group referred for surgical closure, having a median age of 7.8 versus 3.6 years, and stayed for a shorter period in hospital. Those closed using the device stayed for 2 days, as opposed to a median of 5 days, with a range from 4 to 10 days for those undergoing surgical closure. Closure was complete as assessed by echocar- diography after follow up of 1–3 months in both groups. There were no recognised complications related to insertion of the device, whereas transient postoperative morbidity occurred in 38% of those closed surgically. Insertion of an Amplatzer device was considered to be appropriate in 37% of patients older than 6 months requiring closure of an atrial septal defect in the oval fossa. Keywords: Secundum atrial septal defect; interventional catheterisation; surgery Correspondence to: Dr Ian Sullivan, Consultant in Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, UK. Tel: 144 207 829 8845; Fax: 144 207 829 8673. Research at the Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust benefits from R&D funding received from the NHS Executive. Accepted for publication 6 April 2001