Microtransesophageal Echocardiographic Guidance during Percutaneous Interatrial Septal Closure without General Anaesthesia

Snijder, Roel J.R.; Renes, L E; Swaans, Martin J.; Suttorp, Maarten J.; Berg, Jürrien M. ten; Post, Martijn C.

doi:10.1155/2020/1462140

Cited by 6 publications

(12 citation statements)

References 31 publications

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“…Because there is no evidence that one modality has a lower residual shunt than the other, it is important to look at complications, costs and patient comfort. We found no significant difference in residual shunts between the TEE-and micro-TEE group [104]. Although a non-significant increase in shunt rate in the micro-TEE group was seen, it is unclear why this difference occurred.…”

Section: Residual Shuntscontrasting

confidence: 63%

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Closure of the interatrial septum: should we do it?

Snijder¹

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Percutaneous closure of a patent foramen ovale (PFO) and atrial septal defect (ASD) is performed frequently. Especially PFO closure has been a subject for discussion but has proven its worth for cryptogenic stroke in patients less than 55 years of age. Closure is also performed for transient ischemic attack (TIA) and sometimes migraine with aura. However, the level of evidence is low for these indications. Many devices have been developed and improved over the years. Some showed to be effective and safe, whereas others are no longer used. Cardiac imaging during these interventional procedures is essential. Transesophageal echocardiography (TEE) is the gold standard at this moment, but the technique keeps on developing to make it less invasive with a reduction in costs. The micro-probe TEE has been described for several percutaneous procedures for structural heart disease, but not for percutaneous ASD-and PFO closure. General introduction and outline of the thesis Chapter 1 13 General introduction and outline of the thesis Chapter 1 17 General introduction and outline of the thesis Chapter 1 19

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Section: Residual Shuntscontrasting

confidence: 63%

“…There was no difference between TEE and micro-TEE in our study as well, nor was there between general-and local anesthesia [104].…”

Section: Complicationssupporting

confidence: 44%

Closure of the interatrial septum: should we do it?

Snijder¹

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“…At present, transcutaneous ASD occlusion under echocardiography guidance is commonly through the femoral vein. [4][5][6][7][8][9] But this method has a long operation path and needs long bedrest after femoral vein puncture.…”

Section: Discussionmentioning

confidence: 99%

“…Seol, 6 Sharfi, 7 Lu, 8 Snijder, 9 and Zhang, 12 have all reported transcutaneous close ASD under echocardiography guidance. At present, transcutaneous ASD occlusion under echocardiography guidance is commonly through the femoral vein 4–9 . But this method has a long operation path and needs long bedrest after femoral vein puncture.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, echocardiography guided transcutaneous closure of ASD has gradually been applied. At present, the most common approach for transcutaneous ASD occlusion under the guidance of echocardiography is through femoral vein 4–9 . However, this approach requires a relatively long operation path and the patient requires a long period of bedrest after femoral vein puncture.…”

Section: Introductionmentioning

confidence: 99%

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Trans‐jugular transcutaneous closure of atrial septal defects with an adjustable curved sheath under echocardiography guidance

Hu,

Zhang,

2023

Echocardiography

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Introduction and ObjectivesTraditional transcatheter closure of atrial septal defect (ASD) via the femoral vein carries risk of radiation damage. Transcutaneous closure of ASD under echocardiography guidance avoids radiation exposure and can be gradually applied. An alternative is to transcutaneous closure of ASD trans‐jugular with an adjustable curved sheath under echocardiography guidance.MethodsWe retrospectively studied all cases of trans‐jugular transcutaneous closure of ASD with an adjustable curved sheath under echocardiography guidance in the Heart Center of Henan Province People's Hospital between 2016 and December 2022.ResultsA total of 156 patients were included, 74 males and 82 females. Mean age was 6.9 ± 7.4 years and weight 23.7 ± 14.6 kg. Mean sizes of the ASD and occluder were (9.7 ± 4.7) mm and (14.1 ± 5.7) mm. The mean operation time was (49.6 ± 29.2) min. No complications such as atrioventricular block, reoperation, or pericardial effusion occurred. There are 3 patients had a residual shunt. All patients were followed‐up for (38.7 ± 11.0) months. The three patients with residual shunt had self‐closed at the 3–6–12 months follow‐up. There was no complication at follow‐up.ConclusionTrans‐jugular transcutaneous closure of ASD with adjustable curved sheath under echocardiography guidance is safe, effective and minimally invasive.

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Comparative evaluation of microprobe versus conventional transoesophageal echocardiography for PFO closure guidance

Lanki,

Tuohinen,

Simonen

et al. 2024

Open Heart

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BackgroundPatent foramen ovale (PFO) closure is traditionally guided by transoesophageal echocardiography (TEE) under general anaesthesia, which prolongs procedure duration and increases costs and risks. A transnasal echocardiography with a microTEE-probe (microTNE) is tolerated under conscious sedation and offers an effective alternative to TEE. The aim of this study was to compare the feasibility, safety and time expenditure of PFO closure using conventional TEE versus microTNE guidance.MethodsConsecutive patients assigned for PFO losure in Helsinki University Hospital from 2003 to 2021 were included in the study (n=336). TEE with general anaesthesia was used until November 2018 (n=167) while microTNE-guided PFO closure (n=169) under conscious sedation was the principal method thereafter. Patients were followed for 3 months after PFO closure.ResultsThe microTNE-route success rate was 97.2% vs TEE 100% (p=0.06) and procedure success rate was 97.7% with microTNE and 96.0% with TEE-guidance (p=0.54). The procedure time was significantly shorter with microTNE 21±7 min than with TEE 30±13 min (p<0.001). At the beginning of microTNE era, nasal bleeding complication was quite frequent; however, overall complication rates were equal between the groups. However, C reactive protein (CRP) increase was significantly milder with microTNE than TEE 1.0±2.9 vs 3.0±4.0 mg/L (p<0.001). An increase in CRP was independently associated with procedure type (p=0.004) and time (p=0.003).ConclusionsMicroTNE is a feasible and safe alternative for PFO closure guidance. MicroTNE under conscious sedation shortens procedure duration and induces a milder inflammatory reaction than conventional TEE under general anaesthesia.

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Microtransesophageal Echocardiographic Guidance during Percutaneous Interatrial Septal Closure without General Anaesthesia

Cited by 6 publications

References 31 publications

Closure of the interatrial septum: should we do it?

Closure of the interatrial septum: should we do it?

Trans‐jugular transcutaneous closure of atrial septal defects with an adjustable curved sheath under echocardiography guidance

Comparative evaluation of microprobe versus conventional transoesophageal echocardiography for PFO closure guidance

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