Transcatheter closure of atrial septal defects under echocardiographic guidance without X-ray: initial experiences

Abstract

We conclude that in selected cases with an atrial septal defect located in the oval fossa and clear-cut echocardiographic findings, an Amplatzer Septal Occluder can be safely deployed under echocardiographic guidance alone.

Experience with transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder: a single centre study in 236 consecutive patients

“…It has even been suggested that ASD closure with the Amplatzer occluder can be carried out under TOE guidance alone. 23 Cobra head malformation of the Amplatzer septal occluder is sometimes difficult to overcome and may prolong the procedure. While it occurred more often in the past with the first generation of Amplatzer devices, it still may happen, particularly if there is not enough space for the configuration of the left or right atrial disc within the left or right atrium in a small patient.…”

Transesophageal echocardiographic predictors for successful transcatheter closure of defects within the oval fossa using the CardioSEAL® septal occlusion device

“…A small number of patients have already undergone placement of devices without fluoroscopy. 23 In conclusion, transesophageal echocardiography is a safe and effective method for evaluating and guiding transcatheter closure of defects within the oval fossa. The examination should be conducted in at least 3 orthogonal planes, paying particular attention to the anterosuperior rim of the defect and the direction of the major axis of the defect.…”

Exposure to ionizing radiation in children undergoing amplatzer device placement to close atrial septal defects

“…These changes have reduced the exposure to ionizing radiation, especially during implantation, where fluoroscopic guidance has been replaced to an important degree by transesophageal echocardiography. Ewert et al [5] reported on the use of transesophageal echocardiography only for Amplatzer device placement without fluoroscopy. Despite this bold attempt to eliminate radiation exposure entirely for ASD occlusion, most centers, including ours, continue to use fluoroscopy during ASD sizing and device placement (as an adjunct to transesophageal echocardiography).…”