Transcatheter closure of atrial septal defects without fluoroscopy - Feasibility of a new method

Background-In an effort to reduce x-ray exposure, we developed a technique for transcatheter closure of atrial septal defects under echocardiographic guidance without fluoroscopy. To assess the efficiency of this procedure fo r routine use, we compared our initial results with those for the conventio nal procedure. Methods and Results-Twenty-two randomly selected patients (median age 18 ye ars; range 2 to 66 years) with atrial septal defects (n=13) or patent foram en ovale (n=9) underwent cardiac catheterization for possible interventiona l defect closure with echocardiography as the only imaging tool. Median str etched diameter was 9 mm (range 6 to 26 mm); median left-to-right shunt ove r the atrial septal defects was Qp/Qs = 1.8 (range 1.5 to 2.6). An Amplatze r septal occluder was successfully implanted in 19 defects without fluorosc opy and in 3 with the help of radiography. After 1 month, complete defect c losure was documented in all patients. Compared with the conventional proce dure of a control group of 131 patients, procedure times were not significa ntly different (88 versus 100 minutes; P=0.09). However, the study group re ceived significantly higher doses of propofol for sedation (9.9 versus 5.6 mg/kg body weight; P=0.002) owing to extended transesophageal echocardiogra phy. Conclusions-In the majority of patients in whom transcatheter closure of in teratrial communications with the Amplatzer septal occluder is possible, th e procedure can be safely performed under echocardiographic guidance withou t fluoroscopy.