Echocardiography-guided percutaneous closure of oval-shaped secundum atrial septal defects

• Published in: BMC cardiovascular disorders Vol. 24; no. 1; pp. 534 - 8
• Main Authors: Siagian, Sisca Natalia, Tandayu, Jr, Kevin Moses Hanky, Reno, Putri, Mendel, Brian, Christianto, Christianto, Prakoso, Radityo
• Format: Journal Article
• Language: English
• Published: England BioMed Central 03-10-2024; BMC
• Subjects: Adolescent; Adult; Adults; Arrhythmia; Atrial septal defect; Cardiac arrhythmia; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Catheters; Child; Child, Preschool; Echocardiography; Echocardiography, Transesophageal; Female; Fluoroscopy; Heart Septal Defects, Atrial - diagnostic imaging; Heart Septal Defects, Atrial - surgery; Heart Septal Defects, Atrial - therapy; Humans; Male; Middle Aged; Morphology; Non-fluoroscopy; Oval-shaped; Patients; Percutaneous; Predictive Value of Tests; Prosthesis Design; Pulmonary hypertension; Retrospective Studies; Septal Occluder Device; Time Factors; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional; Ultrasound; Visualization; Young Adult; China; Atrial septal defect; Non-fluoroscopy; Oval-shaped; Percutaneous
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-024-04165-7

An atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population.
To assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs.
This single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio < 0.75, a circular index of 1.33, or ultrasound visualization of an oval shape. Device size was chosen to be 0-4 mm larger than the defect's longest diameter, based on transthoracic and transesophageal ultrasound measurements.
We identified 78 patients (33.3% children, 20.5% males) with a mean age of 27.4 ± 16.3 years and a mean weight of 46.8 ± 19.8 kg. The mean longest diameter and mean shortest diameter of ASDs were 23.3 ± 6.8 mm and 15.8 ± 5 mm, respectively. The mean ratio of the shortest to longest diameter was 0.7 ± 0.1. Percutaneous closure was not attempted in 7/78 (9%) patients. Three out of 71 (4.2%) procedures were fluoroscopy-guided upfront due to technical difficulties, and 5/71 (7%) were converted to fluoroscopy-guided closure. Overall procedural success rate was 98.6% (70/71) including 63/71 (88.7%) performed with zero fluoroscopy. Mean device size was 26.5 ± 7.1 mm. Mean procedural time was 45.3 ± 22.6 min. Eleven intraprocedural complications occurred including 6 arrhythmias, 3 pericardial effusions, and 2 device dislodgements.
Transcatheter closure of oval-shaped ASD is safe and feasible. Echocardiography is adequate for adequate operative guidance.