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Review
. 2025 Feb 19;27(1):59.
doi: 10.1007/s11886-024-02177-5.

Fluoroscopy-free Transcatheter Atrial Septal Defect Closure: A Simplified Approach

Naychi Lwin  1 , Piia Suursalmi  1 , Sophia Yong  1 , Saleha Kabir  1 , Matthew I Jones  1 , Alexandra Savis  1 , Shakeel A Qureshi  1 , Eric Rosenthal  2
Affiliations
Review

Fluoroscopy-free Transcatheter Atrial Septal Defect Closure: A Simplified Approach

Naychi Lwin et al. Curr Cardiol Rep. .

Abstract

Purpose of review: To provide an overview of fluoroscopy-free transcatheter atrial septal defect (ASD) closure and introduce a simplified approach that avoids pulmonary vein instrumentation.

Recent findings: Since the first reported fluoroscopy-free ASD closure 24 years ago, only a few small series have described this technique. We present a simplified and less cumbersome approach to encourage wider adoption of the fluoroscopy-free method to suitable ASD anatomy.

Results: Fluoroscopy free ASD closure was performed in 9 patients using the conventional technique (Group 1) and 23 patients using our simplified approach of direct placement of the device into the defect (Group 2). Median age and weight were 28 years, 53 kg in Group 1 (range: 5-52 years, 22-88 kg) and 36 years, 66 kg in Group 2 (range: 4-76 years, 16-115 kg). Devices were successfully implanted in all patients, with a median device size of 21 mm (Group 1: 9-36 mm, Group 2: 10-33 mm). Procedural time was 47 min for Group 1 and 35 min for Group 2 (p = 0.09). Length of hospital stay was similar in both groups. There were no acute or long-term complications and no need for reintervention. Transcatheter ASD closure without the use of fluoroscopy using the simplified approach is safe and effective, offers a shorter procedure duration and minimises instrumentation within the left atrium and pulmonary veins. Patient selection is key and with greater experience, this procedure may be applicable to a wider selection of ASD anatomy.

Keywords: Atrial septal defect; Congenital heart disease; Fluoroscopy-free; Transcatheter closure; Transoesophageal echocardiography.

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Conflict of interest statement

Declarations. Funding: No funds, grants or other support was received. Competing Interests: The authors declare no competing interests. Human and Animal Rights and Informed Consent: All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Figures

Fig. 1
Fig. 1
The modified procedure. (A) A 3D transoesophageal echocardiogram image shows the ASD occluder (arrow) advanced within the delivery sheath in the SVC. (B) A small portion of the left atrial disc of the occluder (arrow) is extruded from the end of the sheath in the SVC to form an ‘onion’. (C) The ‘onion’ and delivery sheath assembly (arrow) is rotated towards the ASD. (D) The ‘onion’ and delivery sheath assembly (arrow) is manoeuvred across the defect into the left atrium. (E) The left atrial disc is deployed and positioned. (F) The right atrial disc is deployed in the usual way. Key: SVC: superior vena cava; RA: right atrium, LA: left atrium
See this image and copyright information in PMC

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