Device closure of interatrial communications: peri-interventional echocardiographic assessment

The interventional closure of interatrial communications requires peri-interventional echocardiographic assessment and guidance to make those treatments as safe as possible. Transoesophageal echocardiography (TEE) including real-time three-dimensional (RT-3D) imaging, later complemented and in part replaced by intracardiac echocardiography (ICE), has become established as the standard approach to prepare for and to guide the interventional treatment of interatrial communications. Accurate imaging of the anatomic features of the particular communication is critical for case selection, planning, and intraprocedural guidance. Especially in the atrial septal defect (ASD) closure, which tends to be more challenging than the patent foramen ovale (PFO) closure, a certain risk of severe complications remains and may result from suboptimal device performance. Other complications may be related to discontinuous use of echocardiographic monitoring. Image fusion and RT-3D ICE are currently under clinical testing and might be suitable to facilitate spatial orientation. Nowadays, two-dimensional ICE is the method of choice for guiding percutaneous device closure, especially of ASDs and 'complex' PFOs. Uninterrupted TEE under deep sedation is an alternative. In contrast, the closure of 'simple' PFOs will often require nothing but final confirmation of the result, and therefore, short echocardiographic viewing is sufficient in many cases.