Contemporary echocardiographic guiding tools for device closure of interatrial communications

Periinterventional echocardiographic guidance is considered desirable in order to make interventional closure of interatrial communications safe and straight forward. Transesophageal 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 guide those procedures. Especially in atrial septal defect (ASD) closure, which tends to be more challenging than 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, closure of "simple" PFOs will often require nothing but final confirmation of the result, and therefore, short echocardiographic viewing is sufficient in many cases.