The Pivotal Role of Advanced Echocardiography in Transcatheter Closure of Challenging Secundum Atrial Septal Defect Anatomies: An Expert-Based Review.

Transcatheter secundum atrial septal defect (ASD) closure is the preferred approach in the majority of cases. Building skill sets through understanding complex ASD anatomies is essential. Such anatomies include ASD associated with aneurysmal septum, multiple defects, absence of anterosuperior or posteroinferior rim and malaligned septum This expert-based review will focus on the key role of advanced TOE imaging during transcatheter ASD closure in challenging anatomies. We describe our institutional experience and provide a practical approach of how to plan and navigate device choice and its delivery to ensure optimal outcomes.