Preprocedural Transthoracic Echocardiography Can Predict Amplatzer Septal Occluder Device Size for Transcatheter Atrial Septal Defect Closure.

OBJECTIVE: To evaluate whether preprocedural transthoracic echocardiography (TTE) can be used to predict Amplatzer septal occluder (ASO) size for device closure of atrial septal defect (ASD).

DESIGN: Retrospective review of patients who underwent ASD device closure at our institution between August 2006 and August 2013 was performed. Patients with complex congenital heart disease, devices other than the ASO, multiple devices, or inadequate TTE images were excluded. Those who had transesophageal echocardiography (TEE)-guided device placement were evaluated. A blinded observer reviewed their preprocedural TTE images and applied a scaled formula to predict device size.

RESULTS: A total of 186 patients underwent ASO placement during the study period, 87 had TEE guidance, of which 45 met inclusion criteria. The mean predicted device size by the scaled formula was 18.0 ± 5.11 mm, compared to the mean implanted device size of 18.8 ± 5.22 mm. The mean absolute difference between each predicted and final deployed device size was 1.44 mm with 95% CI [1.08, 1.81]. The Pearson correlation showed that the predicted device size had a positive correlation coefficient of 0.94.

CONCLUSION: Preprocedural TTE assessment of ASD size using a scaling formula in patients with adequate TTE windows can accurately predict ASO device size and aid in device selection.