Procedural success and complications of transthoracic echocardiography guided atrial septal defect device closure in children at a tertiary cardiac center in Nepal

Background

Although transthoracic echocardiography (TTE) is easy and more widely available with excellent acquisitions in children, there is limited evidence regarding its use in guiding transcatheter closure of ASD.

Objectives

We aimed to evaluate the safety, feasibility, and outcome of transcatheter closure of ASD in children guided by TTE in combination with fluoroscopy.

Methods

All children aged 4–15 years who were considered for and underwent transcatheter ASD closure of ASD Secundum type under TTE and fluoroscopy guidance at the National Heart Centre in Kathmandu, Nepal, from August 2018 through May 2021, were retrospectively reviewed.

Results

Of the 94 children, transcatheter closure was attempted in only 89 patients, and implantation of the device was successful in all of them (100 %). The procedure was done under total intravenous anesthesia in 79.8 % of children and local anesthesia in the rest. The ASD size varied between 7 and 32 (15.2 ± 5.8) mm. ASDs were closed using the device size ranged between 10 and 38(19.2 ± 1) mm. The mean of device/patient weight and device/ASD size ratio were 82 ± 0.33 and 1.28 ± 0.25, respectively. Similarly, mean duration of the procedure and fluoroscopy was 31.2 ± 8.6 and 6.5 ± 2.8 min, respectively. Five children (5.6 %) had tiny residual shunt, which closed spontaneously, as documented by TTE within 6 months after the procedure. A new onset atrial tachycardia was detected in one child during follow up. Otherwise, we observed no major early postprocedural or late complications during follow up period of 18.4 ± 8.5 months.

Conclusion

TTE is a safe and feasible guiding tool in children with adequate acoustic windows for the deployment of the ASD device under fluoroscopy.