Transcatheter closure of atrial septal defect using intracardiac echocardiography: a two-center, retrospective study

Author:

Lucarelli Katya1,Acquaviva Tommaso2,Ferrero Paolo3,De Cillis Emanuela2,Casamassima Vito1,Basile Eloisa1,Cacciapaglia Erasmo1,Iorio Elia1,Martimucci Marcello1,Cecere Giacomo1,Petti Pierpaolo1,Caruso Rosa1,Langialonga Tommaso1,Bortone Alessandro2,Grimaldi Massimo1,Chessa Massimo4

Affiliation:

1. Department of Cardiology, ‘F. Miulli’ Hospital, Acquaviva delle Fonti

2. Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari

3. ACHD Unit, IRCCS Policlinico San Donato

4. ACHD Unit Head, IRCCS Policlinico San Donato & Vita Salute San Raffaele University, Milan, Italy

Abstract

Aims We present the experience and long-term results of intracardiac echocardiography (ICE)-guided closure of ostium secundum atrial septal defects (ASDs) in two Italian centers and investigate its systematic applicability as the gold standard in routine clinical practice. Methods We retrospectively evaluated all consecutive patients who underwent an ASD percutaneous closure procedure from March 2008 to February 2020. All patients underwent a preprocedural transesophageal echocardiography (TEE) evaluation. The closures were carried out under fluoroscopic and ICE guidance. A follow-up visit was performed at 1, 3 and 12 months, followed by telephone evaluations approximately every 2 years. Results Sixty-six patients (29% male individuals), mean age 43 ± 16 years, were treated. In 15 cases, the TEE defect diameter was less than 10 mm, and in 8 of these patients, the ICE intraprocedural sizing increased the maximum diameter by more than 5 mm. Sizing balloon of the defect was performed in 51 cases; 2 patients received an ASD 38 mm device. Eight patients had multiple defects; in three of these, it was necessary to apply two devices. Four patients showed nonsignificant residual shunt; no complications related to the use of ICE were observed. One patient presented the migration of the ASD device into the abdominal aorta, percutaneously retrieved with a snare. No major complications were recorded during the entire follow-up period. Conclusion This study confirms that ICE monitoring during ASD percutaneous closure is well tolerated and effective; it might be achievable as a routine gold standard by operators willing to use ICE systematically in all transcatheter closure interventions of interatrial communications.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference17 articles.

1. Imaging assessment of the interatrial septum for transcatheter atrial septal defect and patent foramen ovale closure;Bechis;Interv Cardiol Clin,2017

2. Role of echocardiography in the diagnosis and interventional management of atrial septal defects;Rao;Diagnostics (Basel),2022

3. 2020 ESC Guidelines for the management of adult congenital heart disease;Baumgartner;Eur Heart J,2021

4. Eight-French intracardiac echocardiography - safe and effective guidance for transcatheter closure in atrial septal defects;Kim;Circ J,2012

5. Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn;Bartel;Eur Heart J,2014

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