Children with a secundum atrial septal defect are usually asymptomatic and are referred for elective closure after 3–4 years of age; however, in premature infants with chronic lung disease, bronchopulmonary dysplasia, or pulmonary hypertension, increased pulmonary blood flow secondary to a left-to-right atrial shunt, may exacerbate their condition. Closure of the atrial septal defect in these patients can result in significant clinical improvement. We report the cases of two premature infants with chronic lung disease, who underwent atrial septal defect closure with the Gore HELEX Septal Occluder and discuss the technical aspects of using the device in these patients and their clinical outcomes.

The α-tocopherol content of a number of different fetal, neonatal and maternal guinea-pig tissues was determined and compared with plasma and erythrocyte α-tocopherol values. During late gestation, the fetal liver appears to act as a storage site for α-tocopherol, the majority of which is released immediately following birth. In contrast, lung and brain vitamin E levels are relatively constant over the final period of gestation and during early neonatal life. The ontogeny of α-tocopherol in brain and lung was similar to that for erythrocytes while plasma α-tocopherol content varied considerably and did not accurately reflect tissue α-tocopherol status. Surprisingly, fetal and maternal lung α-tocopherol concentrations were similar at all time-points considered, whereas fetal liver α-tocopherol status was always considerably greater than maternal liver α-tocopherol content. These results, if representative of the human fetus, suggest that preterm infants may not have tissue α-tocopherol concentrations as low as previously assumed and that during the perinatal period erythrocyte α-tocopherol content is a more accurate indicator of tissue α-tocopherol concentration than plasma α-tocopherol content.