The safety and effectiveness of a modified guidewire pigtailing technique in transesophageal echocardiography-guided percutaneous closure of secundum atrial septal defects.

BACKGROUND: To evaluate the safety and effectiveness of a guidewire pigtailing technique in percutaneous atrial septal defect(ASD) closure guided by transesophageal echocardiography guidance. METHODS: We retrospectively collected and analyzed clinical data of 137 patients who underwent transesophageal echocardiography(TEE) guided percutaneous secundum atrial septal defect closure from September 2022 to December 2024 at the Department of Cardiovascular Surgery in the Second Affiliated Hospital of Nanjing Medical University. Patients were divided into the study groups (guidewire pigtailing group, with the guidewire tip looped within the left atrium, n = 78) and the control group (with the guidewire tip positioned in the left superior pulmonary vein, n = 59) based on the surgical technique used. The technique’s success rate, operation time, postoperative new-onset arrhythmia, pericardial effusion, residual shunt, and vascular access-related complications were compared between the two groups. RESULTS: Gender, age, atrial septal defect diameter, follow-up time, and operation time between the two groups were comparable ( P > 0.05 ). Surgical success was achieved in all 137 patients. Within the study group, four cases developed new-onset postoperative arrhythmias, including two cases of premature atrial contractions(PACs) and two cases of incomplete right bundle branch block(IRBBB). In the control group, one patient was converted to the pigtailing technique due to difficulty advancing the guidewire into the left superior pulmonary vein(LSPV), and one case developed new-onset pericardial effusion, which decreased after one week of observation and resolved completely at three-month follow-up; one case experienced a puncture site hematoma, which improved with compression bandaging; and three cases developed new-onset postoperative arrhythmias, all diagnosed as IRBBB. The two groups of patients completed 3 ~ 15 months of follow-up. Follow-up data were comparable between groups, with no residual shunt, occluder dislodgement, and access site related complications. CONCLUSION: The guidewire pigtailing technique for percutaneous secundum atrial septal defect closure under transesophageal echocardiography guidance was found to be a safe and feasible procedure, which may help reduce the learning curve and procedural complexity, and serves as a valuable alternative to the standard LSPV access.