Transcatheter closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim under echocardiography only: a feasibility and safety analysis

Abstract

Background: The safe closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim is a controversial issue. Few studies have been conducted on the closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim without fluoroscopy. This study evaluated the feasibility and safety of echocardiography-guided transcatheter closure of atrial septal defect with deficient posterior-inferior or inferior vena cava rim. Methods: The data of 136 patients who underwent transcatheter atrial septal defect closure without fluoroscopy from March 2017 to March 2020 were retrospectively analysed. The patients were classified into the deficient (n = 45) and sufficient (n = 91) posterior-inferior or inferior vena cava rim groups. Procedure and the follow-up results were compared between the two groups. Results: Atrial septal defect indexed diameter and the device indexed diameter in the deficient rim group were both larger than that in the sufficient rim group (22.12 versus 17.38 mm/m2, p < 0.001; 24.77 versus 21.21 mm/m2, p = 0.003, respectively). There was no significant difference in the success rate of occlusion between two groups (97.78% in the deficient rim group versus 98.90% in the sufficient rim group, p = 1.000). During follow-up, the incidence of severe adverse cardiac events was not statistically significant (p = 0.551). Conclusions: Atrial septal defect with deficient posterior-inferior or inferior vena cava rim can safely undergo transcatheter closure under echocardiography alone if precisely evaluated with transesophageal or transthoracic echocardiography and the size of the occluder is appropriate. The mid-term results after closure are similar to that for an atrial septal defect with sufficient rim.

Çocuklarda, Ergenlerde ve Genç Yetişkinlerde Transtorasik Ekokardiyografi ve Floroskopi Kılavuzluğunda Cihazla Transkateter Atriyal Septal Defekt Kapatılması

“…Therefore, our study supports that nowadays transcatheter ASD closure with TTE and fluoroscopy guidance and balloon sizing is safe and effective. However, in some recent studies, TTE or TEE-guided transcatheter ASD closure without fluoroscopy guidance has been shown to be feasible, safe, and effective in children and adults (30)(31)(32)(33). Also, It has been reported that successful transcatheter ASD closure can be performed with expert operators without balloon sizing under the guidance of fluoroscopy and TTE in suitable adult cases (34).…”

Can Artificial Intelligence Revolutionize the Diagnosis and Management of the Atrial Septal Defect in Children?

“…Regarding the deficient posteroinferior rim, in their study, Cao et al were able to treat patients with less than 5 mm rims using devices up to 6 mm larger than the maximum measured diameter, and they monitored the rims using TTE and TEE simultaneously [64]. On the contrary, in a study by Huang, the same success rate was achieved in both groups with sufficient and deficient posteroinferior or inferior vena cava rim [65]. Occlusion by percutaneous means may be difficult in large defects with floppy posterior or posteroinferior edges [62,66,67].…”