Transthoracic Echocardiography as a Measuring and Guiding Tool for Transcatheter Device Closure of Secundum Atrial Septal Defect in Young Children

Objective. To analyze the effectiveness of transthoracic echocardiography (TTE) for device closure of secundum atrial septal defect in children <= 5 years old. Study Design. Quasiexperimental study. Study Location and Duration. The study was conducted at Armed Forces Institute of Cardiology and National Institute of Heart Diseases from December 1, 2010 to December 31, 2012. Patients and Methods. During the study period, a total of 48 children <= 5 years old underwent device closure of secundum atrial septal defect. The indications for closure were: elective closure in 31; parental anxiety in 10; frequent respiratory infection in 4; severe pulmonary stenosis in 2; and severe mitral stenosis in 1 patient. The procedure was carried out under general or local anesthesia with TTE and fluoroscopic guidance. TTE was the primary tool used for measurement of defect and estimation of occluder size as well as guiding equipment during device deployment in all patients. Results. A total of 47/48 patients (97.9%) had successful closure of secundum atrial septal defect. The mean age was 4.1 +/- .68 years (range, 2.5-5 years) and 28/48 patients (58.4%) were female. The defect size and occluders used were between 5-20 mm (mean, 12 +/- 3.5 mm) and 8-22 mm (mean, 15 +/- 3.9 mm), respectively. Three patients had simultaneous procedures comprising pulmonary balloon valvuloplasty in 2 patients and percutaneous transmitral commissurotomy in 1 patient. The device embolization occurred in 1 patient; the device was retrieved percutaneously and the patient was referred for surgical closure. The minor complications were residual leak (n = 1), transient bradycardia (n = 4), and first-degree heart block (n = 1). The median procedure time was 30 min (range, 15-100 min) and median fluoroscopic time was 6 min (range, 1.50- 45 min). There were no emergency surgical explorations, cardiac perforations, vascular injuries, or deaths during this period. Conclusion. TTE can be used as a primary tool for the measurement of atrial septal defect and guidance during device deployment in young children by skilled and professional hands, yet more experience is awaited.