Transthoracic echocardiographic guidance during transcatheter closure of atrial septal defects in children and adults

Abstract

The purpose of this study was to evaluate the safety and efficacy of transcatheter atrial septal defect (ASD) closure guided by transthoracic echocardiography (TTE). Since 2004, ASD closure was performed successfully in total 337 patients. Transthoracic echocardiography guidance was used in 206 patients (61.1%) (group 1). Closure was guided by transesophageal echocardiography under general anesthesia in patients with poor transthoracic acoustic windows, defects with aneurysmatic septum and/or multiple defects in 131 patients (38.9%) (group 2). The median age (9 vs. 16 years, P < 0.001), mean defect diameter (14.9 ± 4 vs. 17.2 ± 5 mm, P < 0.001), ratio of complex atrial septal defect (14 vs. 34%, P = 0.01), the median balloon stretch dimensions (21 vs. 18.7 mm, P = 0.003) and the median device diameters (22 vs. 19 mm, P < 0.001) were significantly greater in group 2 compared to group 1. Both the median procedure time and the median fluoroscopy time was significantly shorter in group 1 (60 vs. 75; and 13 vs. 16.5 min; P < 0.0001 and P < 0.0001, respectively). The incidence of residual shunt did not differ significantly in two groups during follow up. Transthoracic echocardiography guidance during transcatheter ASD closure is safe and effective in children and in many adults. Even complex ASDs could be closed with TTE in patients with good acoustic windows. Performing the procedure under TTE guidance significantly reduces procedure time and also provides increased patient's comfort.

Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

“…Our main finding is that in experienced hands, 2D-TTE associated with balloon-sizing is a valuable alternative to 2D-TEE for ASD closure guidance. Our results are in accordance to other groups (30,31). TTE-guidance is not universally accepted and published data are limited to either small series or selected patients (10)(11)(12).…”

“…Our results are in accordance to other groups (30,31). TTE-guidance is not universally accepted and published data are limited to either small series or selected patients (10)(11)(12). However one monocenter prospective randomized study suggested non-inferiority of 2D-TTE compared to 2D-TEE in 40 selected children (11).…”

“…However the rational to consider TTE guidance as an alternative is driven by some rare reports of TEE-related esophageal perforation in adults and children (6)(7)(8), as well as the fact that TTE-guidance may allow to shorten both procedure time and fluoroscopy time (30) and to avoid general anesthesia and orotracheal intubation in spontaneously breathing children (30,31). Additionally, one can present the argument that in TTEguided procedures, the interventionist may be able to complete the whole process himself without the need for an additional echographist and without additional irradiation (10,30). We report here a routine experience on 2D-TTE guided ASD closure in 256 unselected children compared to 133 2D-TEE guided procedures.…”

“…However, TEE use may lead to oropharyngeal and oesophageal traumas (6)(7)(8), and ICE is expensive and require an additional large venous access (9). Given a good echocardiographic window in children, transthoracic echocardiographic (TTE) guidance has been proposed (10)(11)(12)(13). However this approach is not universally accepted (14,15) and most publications report either small or old series, always on selected patients (10)(11)(12)(13).…”

“…Given a good echocardiographic window in children, transthoracic echocardiographic (TTE) guidance has been proposed (10)(11)(12)(13). However this approach is not universally accepted (14,15) and most publications report either small or old series, always on selected patients (10)(11)(12)(13). We aimed in this study to compare efficacy and safety of 2D-TTE versus 2D-TEE to guide percutaneous ASD closure in a large, unselected, consecutive pediatric population.…”