Intracardiac Echocardiography and Percutaneous Closure of Atrial Septal Defects in Adults

Abstract

Today, the transcatheter treatment of atrial septal defects using an occluding device is a safe and effective therapeutic approach. Recently, intracardiac echocardiography has been developed as an alternative to transesophageal echocardiography for guiding these procedures. We describe our experience with intracardiac echocardiography during the percutaneous closure of atrial septal defects in adult patients. This retrospective study involved 52 patients with atrial septal defects (77% with an ostium secundum defect and 23% with patent foramen ovale) who underwent transcatheter closure using an Amplatzer device under intracardiac echocardiographic guidance and without the need for general anesthesia or orotracheal intubation. Clinical follow-up was carried out at 24 hours, and 6 and 12 months, and with transthoracic echocardiograhy at 24 hours and 6 months. The procedure was successful in 51 (98%) of the 52 patients. No serious complication was recorded. Three patients suffered paroxysmal atrial fibrillation in the following weeks, which resolved with medical treatment. At 6 months, echocardiographic examination confirmed that there was no residual shunting across the atrial septum in any patient. Intracardiac echocardiography provided accurate anatomical information about the atrial septum and other intracardiac structures. The technique's use during the transcatheter closure of atrial septal defects using an occluding device was straightforward. In addition, the procedure was less uncomfortable for patients than transesophageal echocardiography because there was no need for general anesthesia or orotracheal intubation.