Reliability of Transthoracic Echocardiography to Guide Transcatheter Closure of Atrial Septal Defects

Introduction: Transthoracic echocardiography (TTE) is used for the pre-interventional assessment of atrial septal defects (ASDs). However, the efficacy of TTE for guiding transcatheter closure of ASD still has not been widely assessed. The aim of this study was to evaluate the efficacy, and reliability of TTE in pre selecting ASDs for transcatheter closure using the Occlutech Figulla ASD occluder. Patients & methods: This was a prospective study carried out between April 1, 2019 and February 1, 2020. Forty-nine patients were referred for transcatheter closure of their ASDs at mean age of 22±18 years and mean weight of 36±17 kg. TTE was used to measure the largest ASD diameter in different views. The device diameter used for closure was chosen based on the largest diameter obtained by TTE plus 3-5 mm if ASD 20 mm. Results: The patients divided into two groups according to the size of ASD, group A when the size of the defect was 20 mm. The average size of the defects for group A 16±4 mm, and 28±6mm for group B. the average size of the devices used was 19±5mm, and 33±7 mm for group A and B respectively. Transcatheter closure of ASD was successful in 41 patients (83.6%), and failed in 8 patients (16.4%). In 7 out of the 8 failed cases, the closure was achieved successfully using transesophageal echocardiography (TEE) guidance and one patient, was referred for surgical closure due to an acute complication due to large pericardial effusion and tamponade that resulted from injury to the left atrial appendage. The successful rate for selection of the appropriate ASD device was 83.6%. Conclusion: this study demonstrated that TTE is satisfactory & reliable in selecting the appropriate ASD device size & in guiding transcatheter closure of ASD.