Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

Abstract

Background: 2D-transesophageal echocardiography (TEE) is routinely performed to guide percutaneous ASD closure in children. We aimed to assess whether two-dimensional (2D)-transthoracic echocardiography (TTE) is a safe alternative for assessment and guidance of atrial septal defect (ASD) closure in unselected children.Methods: We performed a retrospective single-center study including 389 consecutive children aged Results: ASDs were larger and rims deficiencies were more frequent in the TTE-guided group. The procedure was successful in 376 patients [96.7%; 95% confidence interval (CI), 94.4-98.2%]. The success rate tended to be higher in the TTE-versus TEE-guided group (98.0% versus 94.0%, P=0.069). Device migration occurred in 4 patients (1.0%; 95% CI: 0.3-1.6%), all after TEE-guided procedure (P=0.013).Early major adverse events were observed in 5 patients (1.3%; 95% CI: 0.4-3.0%), all in the TEE group (P=0.004). Fluroroscopic time and irradiation dose were not different among the 2 groups (P=0.450 and P=0.130 respectively). After a median follow-up of 7 years (range, 1-16 years), no adverse events was reported. One (0.3%, 95% CI: 0-1.4%) 12-year-old patient developed atrial fibrillation 5 years after the procedure. Pregnancies were uneventful in 72 cases.Conclusions: When a balloon sizing is performed, 2D-TTE imaging is as efficient as 2D-TEE to guide percutaneous ASD closure in children. The procedure can safely be done in spontaneously breathing children under TTE guidance alone in experienced centers.

Transcatheter closure of atrial septal defect: principles and available devices

“…However, intracardiac echocardiography (ICE) is gradually replacing the role of TEE recently. Transthoracic echocardiography (TTE) may also be used especially in patients with good windows for echocardiography such as small children (8). There has been debate on the necessity of balloon sizing for selection of device size.…”

Analysis of the therapeutic effect of transesophageal echocardiography‐guided percutaneous device closure of atrial septal defects via the right internal jugular vein in children

“…Guiding the treatment with radiation carries a risk of radiation‐related damage . Although ultrasound‐guided interventional closure of ASD has no risk of radiation‐related damage, certain requirements with respect to the patient's age and defect size must be met to ensure appropriate vascular status . In this study, we retrospectively evaluated the effect of transesophageal echocardiography (TEE)‐guided ASD device closure via the right internal jugular vein (RIJV) in 19 pediatric patients with different types of ASD treated at the Department of Comprehensive Cardiac Ward, Dalian Children's Hospital, from July 22, 2015 to July 19, 2017, with the goal of establishing a basis for the clinical treatment of ASD in the future.…”

Total endoscopic repair of atrial septal defect under on-pump beating heart

“…Atrial septal defect (ASD) is the third most common type of congenital heart disease with high risk of development of pulmonary vascular disease (1), accounting for 30-40% of congenital heart diseases in adults (2). Although catheterization and Amplatzer occlusion devices have been widely applied (3)(4)(5), surgical procedures are still required for some large, complex and special ASDs. Over the past few years, a number of endoscopic cardiac procedures with or without the da Vinci Surgical System have been reported (6)(7)(8).…”