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Updated: Aug 24, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Percutaneous closure of interatrial communications in adults - prospective embolism prevention study with two- and
Fabian Knebel1, Volker Gliech, Torsten Walde
1Medical Clinic for Cardiology, Angiology, Pulmology, Charité Campus Mitte, Berlin, Germany. fabian.knebel@charite.de
Insights
Transcatheter closure of interatrial communications effectively prevents recurrent embolic events in patients with patent foramen ovale or atrial septal defect, with high success rates and minimal complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Patients with interatrial communications face high risks of recurrent thromboembolism after paradoxical embolic events.
- Transcatheter closure aims to prevent systemic embolism in these at-risk individuals.
Purpose of the Study:
- To evaluate the long-term efficacy of transcatheter closure of interatrial communications in preventing recurrent systemic embolism.
- To assess the role of echocardiography in monitoring closure outcomes.
Main Methods:
- 161 patients with patent foramen ovale or atrial septal defect and prior embolic events underwent transcatheter closure.
- Echocardiography (2D/3D) was used for pre-procedural, early, and late follow-up (12 months).
Main Results:
- Successful device implantation in all patients with low complication rates (2.5% minor).
- Minimal residual shunting in two patients resolved after repeat closure.
- Only one recurrent embolic event (0.6%) occurred during 324.3 patient-years of follow-up.
Conclusions:
- Transcatheter closure of interatrial communications is effective in preventing secondary embolic events for up to one year.
- Device system choice influences outcomes.
- 3D echocardiography enhances understanding and diagnosis of interatrial defects and post-closure status.
Background:
Patients with interatrial communications after paradoxical embolic events are at risk for recurrent thromboembolism. We hypothesized that transcatheter closure of the defects would result in long-term prevention of systemic embolism and performed clinical and echocardiographic follow-up.
Methods:
We included 161 patients (mean age 46.8 +/- 11 years, 83 females) with patent foramen ovale or atrial septal defect and at least one documented paradoxical systemic thrombembolic event and/or a large atrial shunting.
Results:
The implantation procedure was successfully performed without major complications in all patients and minor complications in 2.5%. Two and / or three dimensional echocardiography was performed before and after 4 weeks and 12 months using a multiplane transoesophageal probe. After 4 weeks and 6 months two patients had minimal shunting. These residual defects were closed with a second device implantation without shunting after further 4 weeks. During a follow-up of 324.3 patient years (range, 13 to 19 months), recurrent embolic events occurred in only 1 patient (0.6%).
Conclusion:
After primary paradoxical systemic embolism, results of transcatheter occlusion of the interatrial communications are dependent on the closure device system and can prevent further secondary embolic events for up to 1 year after the percutaneous closure. Three dimensional echocardiography provides dynamic features of the defects and the post closure status and may lead to an improved understanding and diagnosis of the interatrial defect.
