Transthoracic echocardiography guidance of transcatheter atrial septal defect closure in children.

Transesophageal echocardiography (TEE) guidance is part of interventional closure of secundum atrial septal defect (ASD) in children and adults. However, sometimes TEE is impossible for technical or anatomical reasons. If available, intracardiac echocardiography can be used, but especially in children, transthoracic echocardiography (TTE) can be an easy, safe, and cheap alternative. We report two cases in which TEE was replaced by TTE during percutaneous ASD closure. In the first case VACTERL association with a surgically repaired tracheoesophageal fistula was a relative contraindication to TEE. In the second case, technical failure of the transesophageal probe occurred during the procedure. In both cases the ASD was successfully closed with an atrial septal occluder device under TTE guidance. Using TTE can be sufficient and safe in children with good imaging windows, especially from subcostal views.