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Updated: Apr 16, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Validation of a Prescreening Program for Transcatheter Atrial Septal Defect Closure
George T Nicholson1, Robert N Vincent, Christopher J Petit
1Division of Pediatric Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine, 1405 Clifton Road, NE, Atlanta, GA, 30322-1062, USA.
Insights
Implementing a prescreening protocol for atrial septal defect (ASD) device closure significantly reduced unsuccessful procedures. This evaluation ensures patient suitability and improves family counseling for ASD treatment.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- A significant percentage of patients referred for atrial septal defect (ASD) device closure had anatomy precluding the procedure, leading to workflow inefficiencies.
- This highlights the need for a structured prescreening process to optimize patient selection and resource allocation.
Purpose of the Study:
- To evaluate the effectiveness of a comprehensive prescreening protocol for pediatric patients undergoing atrial septal defect (ASD) device closure.
- To assess the impact of this protocol on procedural success rates, patient selection, and family counseling.
Main Methods:
- Retrospective study of pediatric patients undergoing ASD prescreening, including transthoracic echocardiogram and family consultation.
- Analysis of data from January 2011 to June 2013 at Children's Healthcare of Atlanta.
- Comparison of outcomes before and after implementation of the formal prescreening process.
Main Results:
- The prescreening protocol identified 29% of patients as unsuitable for device closure.
- Successful transcutaneous ASD device closure was achieved in 56.5% of screened patients.
- The incidence of unsuccessful ASD device closure decreased from 30% to 10.3% after implementing the prescreening program.
Conclusions:
- A comprehensive ASD prescreening evaluation and family consultation process improves the likelihood of successful device implantation.
- This protocol enhances patient selection, reduces procedural failures, and facilitates adequate preprocedural counseling.
- Implementing a prescreening program is crucial for optimizing the management of atrial septal defects requiring device closure.
Abstract:
Prior to initiation of a formal screening program, 30 % of patients referred for device closure of an atrial septal defect (ASD) at our institution had atrial septal anatomy which precluded ASD device closure. This resulted in inefficiencies in workflow, staff utilization, and inconvenience for families. Our objective was to report our experience with an ASD prescreening evaluation/protocol and family consultation process. This is a retrospective study of pediatric patients who underwent a comprehensive ASD prescreening evaluation at Children's Healthcare of Atlanta between January 2011 and June 2013. The comprehensive prescreening process included a detailed transthoracic echocardiogram and family consultation. Upon establishing a formal prescreening process for patients with secundum ASDs, 138 patients were screened for appropriateness of ASD device closure. At time of prescreening, 40 patients (29 %) were deemed not to be suitable candidates for device ASD closure. In 9 patients (6.5 %), after discussion with the interventionalist, parents elected to pursue surgical ASD closure. A total of 78 patients (56.5 %) underwent successful transcutaneous ASD device closure. In addition, there was a significant discrepancy in the reported size of the ASD between the outside evaluation and the ASD size discovered during the prescreening process. The addition of a prescreening program for transcatheter ASD closure has decreased the incidence of unsuccessful ASD closure from 30 to 10.3 %. The use of a comprehensive evaluation process for ASD device closure improves the likelihood of successful device implantation and permits adequate preprocedural counseling for the patient and family.
