Echocardiographic Assessment of Percutaneous Patent Foramen Ovale and Atrial Septal Defect Closure Complications

Abstract

Atrial septal defect (ASD) is a common congenital defect (1 in 1000 live births) and accounts for up to 40% of clinically relevant acyanotic shunts in adults.1 Patent foramen ovale (PFO) is much more common and is present in more than 25% of adults.2,3 The clinical syndromes associated with ASD/PFO represent a significant health burden. Surgical closure is the most common therapy for these defects, and it is associated with low morbidity and mortality. However, it remains a surgical procedure requiring cardiopulmonary bypass, a significant postoperative recovery, and a sternotomy scar that may be undesirable to young patients. Catheter-based techniques for the treatment of ASD/PFO were pioneered by King and Mills in 1975.4 Since then, significant device development and modifications have been made (Table 1). Percutaneous therapy is now the preferred strategy for ASD/PFO closure, by patients and physicians alike, in the absence of complicated anatomy or another indication for traditional cardiac surgery, because it is technically simple and associated with negligible morbidity and mortality.5 Longer-term follow-up, however, remains necessary to more completely evaluate the safety and efficacy of such devices. View this table: Table 1. Summary of Devices Most Frequently Used for Percutaneous Closure of ASD or PFO The role of 2-dimensional (2D) transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) during the assessment and management of ASD/PFO has been demonstrated.6–8 Although universal practice standards, in the form of consensus committee guidelines or professional society recommendations, still have to be established for the use of echocardiography in this context, it is used by a majority of groups who perform these procedures. In our institution, TTE with color Doppler and/or agitated saline contrast injection is most frequently the method used to diagnose interatrial communication. Once the diagnosis has been made and percutaneous closure is deemed clinically appropriate, a careful …