Abstract
Although previous studies showed that transthoracic echocardiography (TTE) can be used to guide transcatheter closure of atrial septal defect (ASD), whether TTE can be used to guide transcatheter closure of secundum ASD with a deficient superior-anterior rim is unknown and this critical issue was addressed in the present study. A total of 280 patients with secundum ASD who underwent transcatheter ASD closure were recruited and divided into groups A and B depending on ASD superior-anterior rim>4 mm (n = 118) or ≤4 mm (n = 162). TTE was used to guide Amplatzer-type septal occluder (ASO) positioning and assess residual shunt. Procedure success was defined as no, trivial and small residual shunt immediately after the procedure as assessed by color Doppler flow imaging. Group A and group B did not differ in complication rate (8.55% vs.7.55%), procedure success rate (98.3% vs. 95.0%) or complete closure rate immediately after the procedure (89.7% vs. 89.3%) or at 6-month follow-up (98.3% vs. 96.8%). The mean procedure and fluoroscopy time in group B were much longer than those in group A. In conclusion, the absence of a sufficient superior-anterior rim in patients undergoing percutaneous closure of secundum-type ASDs using fluoroscopic and TTE guidance is associated with slightly greater device malposition and migration as well as increased procedural and fluoroscopic times, but the overall complication rate did not differ with TTE guidance when compared to historical controls that used TEE guidance.
Highlights
Transesophageal echocardiography (TEE) and/or intracardiac echocardiography (ICE) are commonly used to guide transcatheter closure of secundum atrial septal defects (ASD) in clinical practice [1,2,3,4,5]
Our previous study has demonstrated that transcatheter ASD closure guided by transthoracic echocardiography (TTE) has a high success rate and a low complication incidence similar to TEE-guided procedures, and TEE can be replaced by TTE in most patients undergoing transcatheter closure of ASD, especially in those with the central type of secundum ASD [6,7]
It has been an international consensus that secundum ASD without superior-posterior or inferior-posterior or inferior-anterior rims should be closed surgically. It remains in dispute whether secundum ASD without superior-anterior rim can be closed with Amplatzertype septal occluder (ASO)
Summary
Transesophageal echocardiography (TEE) and/or intracardiac echocardiography (ICE) are commonly used to guide transcatheter closure of secundum atrial septal defects (ASD) in clinical practice [1,2,3,4,5]. It has been an international consensus that secundum ASD without superior-posterior or inferior-posterior or inferior-anterior rims should be closed surgically. It remains in dispute whether secundum ASD without superior-anterior rim can be closed with Amplatzertype septal occluder (ASO). In the United States, the Amplatzer ASD occluder (St. Jude Medical, St. Paul, MN, USA) has not been approved for clinical use in patients with deficient ASD rims, though some studies have shown that transcatheter closure of secundum ASDs with deficient superior-anterior rims is safe and effective [8,9,10,11]. Transcatheter closure of ASDs with deficient superior-anterior rims by means of Amplatzer ASD occluder has been recommended as a relative indication by the 2009 Chinese Medical Association Expert Consensus, published in 2011 [12]
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