Intracardiac echocardiography (ICE) has become an accepted imaging modality to guide device closure of atrial septal defect (ASD) and patent foramen ovale (PFO). The use of ICE to guide device closure of ASDs in small children (< 20 kg) has been very limited. We report on the use of a new, 8 Fr ICE catheter that possesses full color Doppler capabilities to guide device closure of ASDs in small children as well as to guide device closure of ASDs and PFOs in adult patients.