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. 2022 Apr 24;11(9):2394.
doi: 10.3390/jcm11092394.

Intracardiac Echocardiogram: Feasibility, Efficacy, and Safety for Guidance of Transcatheter Multiple Atrial Septal Defects Closure

Jae-Hee Seol  1   2 , Ah-Young Kim  1 , Se-Yong Jung  1 , Jae-Young Choi  1 , Yeon-Jae Park  3 , Jo-Won Jung  1
Affiliations

Intracardiac Echocardiogram: Feasibility, Efficacy, and Safety for Guidance of Transcatheter Multiple Atrial Septal Defects Closure

Jae-Hee Seol et al. J Clin Med. .

Abstract

We aimed to determine the feasibility, efficacy, success, and safety of intracardiac echocardiography (ICE) in transcatheter multiple atrial septal defect (ASD) closure. Of 185 patients with multiple ASDs who underwent transcatheter closure, 140 (76%) patients who weighed <30kg with a narrow distance between defects or in whom single device closure was anticipated were guided by ICE and 45 patients were guided by three-dimensional (3D) transesophageal echocardiography (TEE) with or without ICE. Patients in the ICE group were relatively younger and weighed less than those in the 3D TEE group (p < 0.0001). The ratio of the distance between defects >7 mm was high, and more cases required ≥2 devices in the 3D TEE group than those in the ICE group (p < 0.0001). All patients in the 3D TEE group and seven patients (5%) in the ICE group were operated on under general anesthesia (p < 0.0001). The fluoroscopic time was shorter in the ICE group (13.98 ± 6.24 min vs. 24.86 ± 16.47 min, p = 0.0005). No difference in the complete closure rate and complications was observed. ICE-guided transcatheter and 3D TEE were feasible, safe, and effective in successful multiple ASD device closures, especially for young children and patients at high risk under general anesthesia.

Keywords: intracardiac echocardiography; multiple atrial septal defects; real-time three-dimensional transesophageal echocardiography; transcatheter closure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Implantation of 28, 16 and 12 mm Amplatzer septal occluders guided by real-time three-dimensional transesophageal echocardiography.
Figure 2
Figure 2
Real-time three-dimensional transesophageal echocardiography images during transcatheter closure of multiple atrial septal defects. (A) The defect is seen here, and its size, shape, and distance from the surrounding structures are clearly noted. The posterior and inferior septal rims are poorly visualized. (B,C) The guide catheter is visible across the atrial septum. (D) This photograph shows left disk expansion and stable positioning of the three septal defect closure devices.
Figure 3
Figure 3
Images from intracardiac echocardiography during transcatheter closure of multiple atrial septal defects. (A) Color Doppler imaging shows two atrial septal defects near the posterior and aortic rims. (B) Two devices are seen placed within the atrial septum.
Figure 4
Figure 4
Summary of the echocardiographic tool selection strategy for patients with multiple atrial septal defects requiring transcatheter closure.ASD, atrial septal defect; Bwt, body weight; ICE, intracardiac echocardiography; RT 3D TTE, Real-time three-dimensional transesophageal echocardiography; TEE, transesophageal echocardiography.
See this image and copyright information in PMC

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