Transcatheter device occlusion of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance.

BACKGROUND

Transcatheter device occlusion of atrial septal defects is becoming an effective alternative to surgery. In order to avoid the discomfort of transesophageal echocardiography and the need for general anesthesia we started using intracardiac ultrasound (ICUS) to guide device implantation in adult patients.

OBJECTIVE

To assess the efficacy and safety of transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) assisted by ICUS.

METHODS

Between April 2001 and November 2002, 27 patients with ASD and four patients with PFO were selected for transcatheter device occlusion. Patient selection was based on previous transesophageal echocardiogram and clinical data. All patients were treated without anesthesia or sedation. The percutaneous occlusion technique was assisted by ICUS and fluoroscopy. Morphological aspects of the defect and measurement of its largest diameter were used to select device diameter.

RESULTS

Thirty-one patients were treated (27 with ASD, four with PFO); 21 (68%) were female, mean age was 40.1+/-13.5 years, and mean ASD diameter was 20.1+/-6.4 mm. We implanted ASD Amplatzer occluding devices in all ASD patients, the size being selected by adding 4 to 6 mm to the maximum ASD diameter. The patients with PFO had an Amplatzer PFO occluder. Mean total procedure time was 50.1+/-18.9 minutes and mean fluoroscopy time was 11.7+/-5.9 minutes. All devices were successfully deployed. We had neither complications nor mortality. Follow-up evaluation was performed by transthoracic echocardiography at 24 hours, one, six and 12 months after occlusion. During a mean follow-up period of 8.5+/-7.1 months, all patients were free of symptoms and on transthoracic echocardiographic evaluation at 24 hours all but three patients had complete occlusion (three ASD patients had insignificant residual shunt), with 100% occlusion rate at six months.

CONCLUSIONS

Transcatheter occlusion of atrial septal defects can be effectively and safely performed using ICUS to guide device implantation in selected adult patients.