Background and Objective
Atrial septal defect (ASD) is a common congenital heart defect. The course and impact
of hemodynamically insignificant ASD in end-stage liver disease (ESLD) patients remains
to be elucidated. Our objective is to present our experience in live donor liver transplantation
in children with secundum type of ASD and to find out whether ASD has an impact on
the outcome of liver transplantation.
Patients and Methods
Fourteen recipients (7 male, 7 female) whose median age was 14.2 months (range, 8–28)
were included. The diagnosis of secundum type of ASD was confirmed by transthoracic
2-dimensional Doppler echocardiography preoperatively. The mean Child's score was
9.9, and the mean Pediatric End-stage Liver Disease Score was 14.7. The ASD were classified
based on physiologic–hemodynamic (insignificant vs significant) and structural size
(small [≤4 mm], medium [5–9 mm], or large [≥10 mm]) parameters. Only 1 patient showed
hemodynamically significant ASD based on echocardiography and cardiac catheterization
findings.
Results
Six small ASD spontaneously closed during the waiting period for transplantation.
Four small ASD spontaneously closed posttransplant. The medium- and large-sized ASD
persisted or increased in size posttransplantation. There were no perioperative cardiac
complications. There were no neurologic complications. All patients are alive with
the original grafts. The median follow-up was 49.7 months (range, 19.8–79.4).
Conclusion
Hemodynamic insignificant ASD seems to not impact the outcome of liver transplantation
in children with ESLD. Further, this series demonstrated that transplantation can
be successfully and safely performed in the presence of hemodynamically stable patients
with small- to large-sized ASD.
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Article info
Publication history
Published online: January 03, 2008
Accepted:
August 10,
2007
Footnotes
Partly supported by program project grant NHRI-EX 94-9228SP from the National Health Research Institutes, Taiwan.
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
