Background: This study aimed to summarize percutaneous occluder device closure of atrial septal defects (ASD) through the femoral vein, using guidance by transthoracic echocardiography under local anesthesia without radiation or fluoroscopic guidance.Methods: This was a case series of fourteen patients, 3 males and 11 females, diagnosed with central ASD, the diameter of the defect ranged from 9 to 32 mm, and the patients had no other heart malformations or organ dysfunction. The patients underwent a novel surgical technique of occluder device closure for ASD. The occluder closure procedures were completed through puncture of the femoral vein, and fluoroscopyfree catheter guidance by transthoracic echography without radiation. Results: All of the cases had successful closure of the ASD, without residual shunt or complications. The median operation time was 18.7±22.5 min (range, 12-56 min), with no ICU-stay time and a short hospital stay of 2.3±0.5 days (range, 1-3 days). All patients were followed up for 2 years and there were no cases of residual shunt. All occluders remained in place. Conclusions: Percutaneous occluder device closure of ASDs through the femoral vein with fluoroscopyfree guidance by transthoracic echography without radiation under local anesthesia could be an easy choice for some simple ASD patients, and may also be favored by cardiac surgeons. real-time three-dimensional imaging, alongside technical modifications, and newer concepts for hemodynamic evaluation interventional occlusion has become popular in the pediatric population (2), and now is becoming of interest in adults (3). These improved imaging methods provide high quality imaging allowing accurate anatomical measurement of the maximum defect size, the morphology of the surrounding rim, and allows evaluation of the relationship between the device and septal rim (2). In this study we used transthoracic echocardiography guidance which has been shown to be safe, effective, and easy during transcatheter ASD closure (4). The novelty of this study is that there was also no need for fluoroscopic guidance during the ASD closure.In the present study of patients with simple, centrally located ASDs, we combined the characteristics of interventional and surgical repair using an ASD occluder through femoral vein puncture guided by transthoracic ultrasonography without radiation under local anesthesia. The information we provide should assist clinicians who select a similar method for treatment of simple ASDs.
Methods
Patient selectionFrom May 2014 to July 2016, 14 patients underwent percutaneous occluder device closure through femoral vein guiding by transthoracic echography in the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University. To be eligible for inclusion in the case series the criteria were: (I) aged 18 and over; (II) a secundum ASD (central type) and left-to-right shunt; (III) the diameter of the defect <38 mm; (IV) grade I cardiac function; (V) no or mild tricuspid regurgitation, no right ventricular volume ...
