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Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure

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Abstract

Transesophageal echocardiography (TEE) under general anesthesia (GA) or intracardiac echocardiography (ICE) under sedation is usually used for echocardiographic guidance during transcatheter atrial septal defect (ASD) closure. However, appropriate selection of guidance has not been fully established. Our study aimed to evaluate whether selection of guidance depending on anatomic ASD features and TEE tolerability under sedation contributes to procedure success. On the basis of anatomic ASD characteristics and TEE tolerability under sedation during the pre-procedural TEE, we selected either TEE, ICE, or combined TEE and ICE under moderate-to-deep sedation or TEE under GA for guidance. Anatomic characteristics of the defect, medical costs, complications, and primary outcomes for these four different types of guidance were analyzed. A total of 154 patients were classified into four guidance groups depending on the results of diagnostic TEE under sedation; 11 patients were scheduled for the procedure under GA in advance. Procedures were successfully completed in all but two patients in whom closure guided by TEE under sedation was attempted for an extremely large defect or extensive superior rim deficiency. Two patients who underwent TEE or combined TEE and ICE guidance under sedation were converted to ICE-only guidance due to desaturation or excessive body movement. Device dislodgement was not observed during the procedure or during median follow-up of 1188 days [interquartile range 577–1831]. Appropriate selection of guidance might contribute to successful transcatheter ASD closure.

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Abbreviations

ASD:

Atrial septal defect

GA:

General anesthesia

ICE:

Intracardiac echocardiography

TEE:

Transesophageal echocardiography

USD:

U.S. dollar

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Acknowledgements

This research was not supported by grants from any funding agencies in the public, commercial, or not-for-profit sectors. We would like to express our gratitude to Kaoru Tajiri at University Hospital Kyoto Prefectural University of Medicine in Japan for her valuable advice regarding medical cost.

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Authors

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All authors contributed to study conception and design. Methodology: MY, TY, TN; Data collection and analysis: MY, TY, TN; Writing—original draft preparation: MY; Writing—reviewing and editing: TY, TN, KZ, HS, TS, SM; All authors read and approved the final version.

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Correspondence to Michiyo Yamano.

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All study subjects provided written informed consent.

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Yamano, M., Yamano, T., Nakamura, T. et al. Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure. Int J Cardiovasc Imaging 36, 855–863 (2020). https://doi.org/10.1007/s10554-020-01778-9

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  • DOI: https://doi.org/10.1007/s10554-020-01778-9

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