The role of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects by the Amplatzer septal occluder

Background Our purpose was to determine the role of transesophageal echocar diography (TEE) in the closure of atrial septal defects by the Amplatzer se ptal occluder (ASO) (AGA Medical, Golden Valley, Minn). Methods A total of 240 patients with atrial septal defect (ASD) secundum we re examined by transthoracic 2-dimensional echocardiography (TTE) and TEE t o determine the ASD morphologic features, diameter, and rims. During transc atheter closure TEE was used for determination of the ASD diameter and guid ance of the ASO implantation. Results Sixteen (6%) patients were found not suitable for transcatheter clo sure with TTE, 35 (14%) with TEE, and 2 during catheterization. Twenty-eigh t patients (18%) had partial or total deficiency of the posterior, inferoan terior, or inferoposterior rim, 54 (27%) had a centrally positioned ASD, 92 (46%) had insufficient superoanterior rim, and 9 had multiple ASDs, wherea s 8 had a septal aneurysm associated with a single defect and 4 a multiperf orated aneurysm. A total of 170 patients underwent implantation of ASO. The ASO was correctly positioned in 144 at the first attempt. In the remainder TEE revealed unstable position of the left atrial disk ( 12), opening of b oth atrial disks in the left atrium (5), deployment of the device through t he smaller defect in patients with multiple ASDs (3), and, in 1 patient, th e device was too small and had to be replaced by a larger one. Conclusions Morphologic variations of the ASD are common. TEE is crucial fo r the determination of the ASD morphologic features, diameter, and rims, wh ich are crucial for proper patient selection. TEE allows precise guiding an d positioning of the ASO, which is essential for safe and effective transca theter ASD closure.