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Updated: Dec 29, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Long-Term Follow-Up of Transthoracic Echocardiography-Guided Transcatheter Closure of Large Atrial Septal Defects
Hongwei Dou1, Tong Kan1, Xian Guo1
1Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China.
Insights
Transcatheter closure of large atrial septal defects (ASDs) is feasible and safe using transthoracic echocardiography (TTE) guidance. This minimally invasive approach offers an effective alternative to surgery for many patients with large ASDs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Transcatheter closure of large atrial septal defects (ASDs) is technically challenging and remains controversial.
- Transthoracic echocardiography (TTE) offers real-time imaging guidance for device placement.
Purpose of the Study:
- To evaluate the feasibility and safety of TTE-guided transcatheter closure for large ASDs (≥30 mm).
- To assess immediate and long-term outcomes of this procedure.
Main Methods:
- Retrospective review of 60 patients with large secundum ASDs undergoing device closure guided by TTE.
- Analysis of procedural success, complications, and long-term outcomes including shunt status and pulmonary hypertension resolution.
Main Results:
- Successful device placement in 95% of patients (57/60).
- Median ASD size was 35 mm; 60% had mild to moderate pulmonary hypertension.
- No residual shunts, erosion, or embolization during median 37-month follow-up; 75% of patients with pulmonary hypertension showed resolution.
Conclusions:
- TTE-guided transcatheter closure is a safe and effective option for the vast majority of patients with large ASDs.
- This technique, utilizing devices like the SHSMA occluder, can be a viable alternative to surgical repair.
Abstract:
Transcatheter closure of large atrial septal defects (ASDs) remains controversial. The aim of this study was to evaluate the feasibility and safety of transthoracic echocardiography (TTE)-guided transcatheter closure of large ASDs. Patients with large secundum ASDs (≥ 30 mm) who underwent device closure were retrospectively reviewed. TTE was performed to guide ASD occluder positioning and assess the immediate and long-term outcomes. A total of 60 patients (median age 43.5 years, range 15-78 years) were enrolled in the study. The median ASD size was 35 mm (range 30-42 mm). Mild to moderate pulmonary hypertension was observed in 36 patients (60%). Thirty-one patients (51.7%) had one short rim, and 18 patients (30.0%) had two deficient rims. Placement of the device was successful in 57 patients (95%), and the median device size was 42 mm (range 40-50 mm). Dislodgement of the device occurred in three patients with two deficient rims: a larger device was redeployed in one case, and two patients required surgical repair. During a median follow-up of 37 months (range 6-83 months), no residual shunts, erosion, or embolization were noted, and pulmonary hypertension resolved in 75% of the patients. Thus t vast majority (95%) of large ASDs can be successfully closed percutaneously using the Chinese-made Shanghai Shape Memory Alloy (SHSMA) occluder under TTE guidance. Long-term follow-up showed that transcatheter closure could become a safe and effective alternative to surgery in select large ASDs.
