Transcatheter closure of complex atrial septal defects is efficient under intracardiac echocardiographic guidance

Abstract

Background: Studies on intracardiac echocardiography for transcatheter closure of secundum atrial septal defect (ASD) only include ASDs ≤38mm diameter without rim deficiency.

Aims: To assess transcatheter closure of complex ASDs under intracardiac echocardiography guidance.

Methods: Retrospective study from January 2006 to January 2012 in all consecutive adult patients referred to our centre for percutaneous device closure of ASD. Complex cases were defined as defect>38mm and/or defect with rim deficiency other than the anterior-superior rim.

Results: Transcatheter closure was performed in 93 consecutive adult patients (59 women) with a median age of 48 (18-88) years. Complex cases comprised 17 patients (18%) with a median age of 54 (20-81) years and a median weight of 58 (45-99) kg. Thirteen cases had one or more deficient rims other than the anterior-superior rim, whereas nine had an ASD size>38mm. Transcatheter closure was successful in 14 cases, whereas three cases failed (18%). Minor complications occurred in three patients (18%). All the other non-complex ASDs were successfully closed percutaneously. Among the 93 patients, rim deficiency other than the anterior-superior rim tended to be associated with failure of transcatheter closure (P=0.058).

Conclusion: Transcatheter closure of complex ASDs is safe and effective under intracardiac echocardiographic guidance.

Keywords: ASD/PDA/PFO closure; Adult congenital heart disease; CIA/canal artériel/FOP fermeture; Cardiopathie congénitale de l’adulte; Imagerie par échocardiographie intracardiaque; Intracardiac echocardiography imaging.