Selection of Device Size for Atrial Septal Defect Closure Using Transesophageal Echocardiography Without Balloon-Sizing : Experience at Queen Alia Heart Institute

Abstract

Objective: To report our experience of percutaneous atrial septal defect closure using different devices, stressing the role of transesophageal echocardiography in defect sizing between December 2010 and December 2012. Methods: Retrospective study of 105 patients that had hemodynamically significant left to right shunt ( ≥1.5:1), atrial septal defect secundum underwent trans-catheter closure of the septal defect using different devices at Queen Alia Heart Institute between December 2010 and December 2012. All the closures were performed under general anesthesia in the catheterization laboratory. Detailed study of the defect with measurement of its dimensions, in at least two planes, was performed in a precise way through transesophageal echocardiography. We reviewed the medical records for the size of the defect measured by the transesophageal echocardiography without balloon sizing and the size of the device selected, looked for immediate complications and follow up transthoracic Echocardiography for residual shunts or any other reported complication at one, three, six months and one year follow up. Results: The patient population consisted of 54 (52%) females and 51 (48 %) males. The mean age was 16.5 years with a range between 6- 63 years. The defect size was between five and 28 millimeters with a mean of 14 millimeters. The device size was between six and 30 millimeters with a mean of 17 millimeters. The upsizing of the device in relation to the defect size measured by transesophageal echocardiography was 3.5mm± 2.5mm. Among 105 cases in which Atrial Septal Defect device closure was attempted, two cases underwent surgical closure of the defect due to multiple failed attempts in device closure and the third patient developed device embolization despite demonstrating stability during the “pull back” technique. The device was retrieved successfully with surgical closure of the defect. Follow ups for the patients showed no residual flow at one month, six months and one year follow up. Conclusion: Secundum atrial septal defect device closure is safe and effective. With increasing experience, device selection for atrial septal defect closure can be accurately done by transesophageal echocardiography without the need for the balloon stretch diameter.