Transcatheter Atrial Septal Defect Closure in Children with and without Fluoroscopy: A Comparison

Area of Science:

• Pediatric Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Atrial septal defect (ASD) device closure is a common pediatric cardiac procedure.
• Fluoroscopy has traditionally been used for guidance during ASD device closure.
• Minimizing radiation exposure in children is a significant clinical consideration.

Purpose of the Study:

• To compare the feasibility, effectiveness, safety, and outcomes of transcatheter ASD device closure with and without fluoroscopy guidance in children.
• To evaluate the role of transesophageal echocardiography (TOE) alone versus fluoroscopy combined with TOE for ASD closure.

Main Methods:

• A retrospective study of 397 children undergoing transcatheter ASD closure between 2002 and 2016.
• Patients were divided into two groups: fluoroscopy ± TOE guidance and TOE guidance alone.
• Comparison of procedural success rates, procedure times, technical events, and complications.

Main Results:

• Successful ASD closure rates were high and similar in both groups (96% vs. 97%).
• Procedures using TOE guidance alone were significantly shorter (median 34 min vs. 60 min).
• Fewer technical intraprocedural events (6.3% vs. 20%) and complications (0.6% vs. 3.3%) were observed with TOE guidance alone.

Conclusions:

• Transcatheter ASD device closure with TOE guidance alone is a safe and effective alternative to fluoroscopy-guided procedures in children.
• This approach offers benefits including reduced procedure time and fewer complications.
• While TOE guidance alone is effective, fluoroscopy may remain valuable for complex cases, necessitating a fully equipped cardiac catheterization laboratory.