Fluoroscopy-free Transcatheter Atrial Septal Defect Closure: A Simplified Approach

To provide an overview of fluoroscopy-free transcatheter atrial septal defect (ASD) closure and introduce a simplified approach that avoids pulmonary vein instrumentation.

Since the first reported fluoroscopy-free ASD closure 24 years ago, only a few small series have described this technique. We present a simplified and less cumbersome approach to encourage wider adoption of the fluoroscopy-free method to suitable ASD anatomy.

Fluoroscopy free ASD closure was performed in 9 patients using the conventional technique (Group 1) and 23 patients using our simplified approach of direct placement of the device into the defect (Group 2). Median age and weight were 28 years, 53 kg in Group 1 (range: 5-52 years, 22-88 kg) and 36 years, 66 kg in Group 2 (range: 4-76 years, 16-115 kg). Devices were successfully implanted in all patients, with a median device size of 21 mm (Group 1: 9-36 mm, Group 2: 10-33 mm). Procedural time was 47 min for Group 1 and 35 min for Group 2 (p = 0.09). Length of hospital stay was similar in both groups. There were no acute or long-term complications and no need for reintervention. Transcatheter ASD closure without the use of fluoroscopy using the simplified approach is safe and effective, offers a shorter procedure duration and minimises instrumentation within the left atrium and pulmonary veins. Patient selection is key and with greater experience, this procedure may be applicable to a wider selection of ASD anatomy.