Objectives: We used to perform transesophageal echocardiography (TEE) under general anesthesia in all patients underwent transcatheter ASD closure during the initial experience. After getting more experience in 24 patients by TEE, we started to use transthoracic echocardiography (TTE) for guidance in all patients if it is possible. We aimed to evaluate the safety and efficacy of transcatheter ASD closure guided by TTE.
Material and method: We analyzed the data of 161 patients with ASD who underwent transcatheter closure after we started to use TTE guidance. Balloon sizing for device selection was performed in all patients. Amplatzer, Cardiofix and Cardia septal occluders were used
Results: 128 ASDs were closed under TTE guidance. Implantation was successful in all and showed complete occlusion without major complication. TEE guidance is performed in 33 patients because of poor transthoracic acoustic windows (16), multiple ASDs (7) and very large defects >25 mm (10). One unsuccessful attempt and two device migrations have observed in TEE group. Defect diameters were similar (18.1±6.6mm vs 16.1±5.5mm) but the age distribution were slightly higher in TEE group (21.1±17.5 vs 14.2±13.0 years; p=0.047). Duration of intervention was significantly shorter in TTE group (66.4±27.3 vs 79.3±26.6 minutes, p: 0.02). Fluoroscopy times were similar.
Conclusion: TTE, as a noninvasive guiding imaging tool, provides accurate definition of the defect anatomy in most of the patients including adults for transcatheter ASD closure. It is possible to avoid the complications of general anesthesia and endotracheal intubation and also save time by using TTE.