[Percutaneous transcather closure of atrial septal defect guided by transthoracic echocardiography and transesophageal echocardiography].

OBJECTIVE

To evaluate the reliability of the combined use of TTE and TEE in guiding percutaneous closure of atrial septal defect.

METHODS

A total of 120 patients were recruited, all accepting TTE and TEE examinations before surgery. The release of ASD occluders was guided by TTE. The patients were divided into two groups. Patients in Group A received ASD occluders with > or = 24 mm diameter. Group B received ASD occluders with < 24 mm diameter. Each group comprised patients with and without retroaortic rim. The patients were followed up with TTE and ECG examinations 24 h, 1, 3 and 6 months after the procedure.

RESULTS

ASD closure was successful for 94% and 100% of the patients in group A and group B, respectively. The difference of the ASD diameter measured by TEE and TTE was (2.7 +/- 2.8) mm in group A and (1.7 +/- 2) mm in group B, P < 0.05. The ASD diameter measured by TEE had a (4.87 +/- 1.10) mm and (4.2 +/- 0.80) mm difference with the diameter of ASD occluders for patients in Group A and Group B, respectively (P < 0.05). The ASD diameter measured by TTE had a (7.51 +/- 2.72) mm and (5.89 +/- 2.26) mm difference with the diameter of ASD occluders for patients in Group A and Group B, respectively (P < 0.05). The ASD diameter measured by TEE had a greater correlation coefficient with the ASD occluder diameter than that measured by TTE. The ASD diameters measured by TEE(x1) and TTE(x2) were both linearly correlated with the ASD occluder diameter(y). There was no difference in the successful rate of ASD closure between the patients with and without deficient retroaortic rim. In group A, the procedure failed in 4 patients; misalignment of the ASD occlude occurred in one patient; one patient suffered from second degree type II atrio-ventricular block; one patient had ischemic cerebral stroke. No such complications occurred in group B.

CONCLUSION

The combined use of TTE and TEE before the intervention procedure and the release of ASD occluder guided by TTE enables high successful closure rate with little complication. It is an effective and safe method. It can be performed in patients with deficient retroaortic rim.