Transoesophageal echocardiography-guided balloon-assisted percutaneous closure of a large secundum atrial septal defect in a pregnant woman: a case report

Abstract

Structured Abstract Background According to 2018 European Society of Cardiology (ESC) guidelines, atrial septal defect (ASD) closure can be performed during pregnancy but is rarely indicated. In this case, we demonstrate the viability of percutaneous balloon-assisted ASD closure without fluoroscopy in a pregnant woman. Case summary A 23-year-old G3P2A0 woman who was 20 weeks pregnant had primary complaints of breathlessness (New York Heart Association functional class (NYHA) fc III-IV for one week prior to admission. Transthoracic echocardiography (TTE) showed dilatation of right atrium, dilated right ventricle, dilated main pulmonary artery (28.1 mm), and an oval-shaped 22x33 mm-sized secundum ASD with left-to-right (L-to-R) shunt. Despite optimal pharmacological treatment, the NYHA fc did not improve. Under transoesophageal echocardiography (TEE) monitoring only, we introduced a 40 mm CeraTM ASD Occluder (Lifetech, China) via the delivery sheath. The device was deployed as usual, however despite numerous placement adjustments, the LA disc keeps being dislodged to RA and could not engage correctly. Therefore, we decided to use balloon-assisted approach using sizing balloon No.34 mm. The device was successfully positioned, a wiggle test was conducted to make sure the device was stable. The patient was able to give birth to the child normally several months later. Discussion Despite the fact that pregnant women with ASD receive a very low dose of radiation, it is nevertheless recommended to avoid radiation because this demographic is particularly vulnerable to it. It is possible to treat large ASD in pregnant women with a successful balloon-assisted approach.

The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately

“…[1][2][3] Recent studies have demonstrated favorable outcomes with device closure of acyanotic CHDs, including atrial septal defect (ASD), ventricular septal defect (VSD), and patent ductus arteriosus (PDA). [4][5][6][7] Concerns over radiation exposure, especially in children and pregnant women, have led to the adoption of non-fluoroscopy techniques for defect closure, with comparable efficacy and safety to traditional methods. In our effort to mitigate radiation exposure during transcatheter closure procedures for congenital heart defects, we have implemented a policy promoting non-fluoroscopy techniques, even in challenging cases such as multiple ventricular septal defects (VSDs) and in pregnant women with atrial septal defect (ASD) with pulmonary hypertension.…”

“…In our effort to mitigate radiation exposure during transcatheter closure procedures for congenital heart defects, we have implemented a policy promoting non-fluoroscopy techniques, even in challenging cases such as multiple ventricular septal defects (VSDs) and in pregnant women with atrial septal defect (ASD) with pulmonary hypertension. 4,5 This strategic shift aims to minimize the potential risks associated with radiation exposure, particularly for vulnerable populations. In one study demonstrated by Siagian et al 6 , echocardiography-guided closure of patent ductus arteriosus (PDA) is a viable alternative to fluoroscopyguided procedures.…”