Safety and efficacy of transthoracic versus transesophageal echocardiography in transcatheter closure of atrial septal defects

Abstract

Objectives:To assess the safety and effectiveness of transthoracic echocardiography (TTE) in monitoring transcatheter closure of atrial septal defect (ASD), in comparison with conventional technique using transesophageal echocardiography (TEE).Methods:A retrospective review of all cases of transcatheter closure of isolated ostium secundum ASDs operated from 2005 to 2015, at the Pediatric Interventional Cardiology Department, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Exclusion criteria included age ≤3 years at the time of the procedure and rim size ≤3 mm. Patients were divided into 2 groups: TTE and TEE group. Demographic and clinical baseline data, procedure data, and outcomes were compared between the 2 groups.Results:We included 77 cases: 45 in TTE group and 28 in TEE (mean ± standard deviation age=8.18 ± 5.85 versus 17.68 ± 14.88), with no significant difference in ASD size, rim adequacy, or other anatomical difficulties. All (100%) patients in TEE group underwent general anesthesia, versus 8.9% in TTE group. Device deployment was comparably successful (97.8% versus 92.9%, p=0.554); while procedure time (76.27 ± 31.80 versus 119.85 ± 19.90 minutes, p<0.001) and fluoroscopy time (11.29 ± 9.04 versus 18.73 ± 11.54 minutes, p=0.003) were significantly reduced in TTE versus TEE. Prevalence of postprocedural complications was comparable in the 2 groups.Conclusion:Transthoracic echocardiography has non-inferior efficacy in device deployment with reference to TEE and superior safety features including significant reduction of procedure and fluoroscopy times and lesser use of general anesthesia.

Optimization of Echo Views for Percutaneous Device Closure of Pediatric Atrial Septal Defect through the Femoral Vein Guided by Transthoracic Echocardiography without Radiation

“…Many experts and scholars have demonstrated that, for a skilled operator, transthoracic ultrasound can replace transesophageal ultrasound for atrial and occlusion guidance under certain conditions [ 11 ]. Azhar reported that transthoracic ultrasound is safer than transesophageal ultrasound in the absence of atrial occlusion, leading to a significant reduction in the operating time, radiation exposure time, and application time of basic anesthesia [ 12 ]. Since echocardiography is two-dimensional, it is critical to accurately determine the position of the catheter.…”

Successful totally transthoracic echocardiography guided transcatheter device closure of atrial septal defect in pregnant women

“…Many experts had proved that TTE can be used as a reliable tool for the measurement of the diameter of ASD and for guidance during device closure by skilled hands, taking the place of TEE in some circumstances[24]. Azhar reported that TTE had the same efficacy in transcatheter closure of ASD compared with TEE and had superior safety, including a significant reduction of procedural time and fluoroscopy times as well as less use of general anesthesia[25]. Pan et al[26] concluded their experience of using TTE guidance as the only imaging tool for the process of percutaneous ASD closure.…”

Mid-term Safety and Efficacy of Transcatheter Closure of Ostium Secundum Atrial Septal Defect under Transthoracic Echocardiographic Guidance in Children Weighing Less than 15 Kg

“…All the patients in the present study underwent ostium secundum atrial septal [5,6,7,18] and limited data is available on transcatheter device closure of ostium secundum atrial septal defect in smaller children (< 15 Kg). The drawback of transesophageal echocardiography is the difficult availability, need for anaesthesia and endotracheal intubation, the morbidity associated, and longer procedural time [19,20].…”