Transcatheter closure of complex atrial septal defects is efficient under intracardiac echocardiographic guidance

Background. - Studies on intracardiac echocardiography for transcatheter closure of secundum atrial septal defect (ASD) only include ASDs <= 38 mm diameter without rim deficiency. Aims. - To assess transcatheter closure of complex ASDs under intracardiac echocardiography guidance. Methods. - Retrospective study from January 2006 to January 2012 in all consecutive adult patients referred to our centre for percutaneous device closure of ASD. Complex cases were defined as defect > 38 mm and/or defect with rim deficiency other than the anterior-superior rim. Results. - Transcatheter closure was performed in 93 consecutive adult patients (59 women) with a median age of 48 (18-88) years. Complex cases comprised 17 patients (18%) with a median age of 54 (20-81) years and a median weight of 58 (45-99) kg. Thirteen cases had one or more deficient rims other than the anterior-superior rim, whereas nine had an ASD size > 38 mm. Transcatheter closure was successful in 14 cases, whereas three cases failed (18%). Minor complications occurred in three patients (18%). All the other non-complex ASDs were successfully closed percutaneously. Among the 93 patients, rim deficiency other than the anterior-superior rim tended to be associated with failure of transcatheter closure (P = 0.058). Conclusion. - Transcatheter closure of complex ASDs is safe and effective under intracardiac echocardiographic guidance. (C) 2014 Elsevier Masson SAS. All rights reserved.