Abstract 17175: Appropriate Selection Criteria Whether Intracardiac or Transesophageal Echocardiography Should be Used for Image Guidance During Transcatheter Atrial Septal Defect Closure Without General Anesthesia
Introduction: Standard transcatheter atrial septal defect (ASD) closure is performed under the guidance of transesophageal echocardiography (TEE) and general anesthesia (GA). However, for adults; especially, old patients with comorbidity, ASD closure without GA might be valuable option. Although intracardiac echocardiography (ICE) guidance has certain limitations in comparison with TEE, it does not require GA. Furthermore, even TEE guidance might be performed without GA in some patients who have enough tolerability for TEE under moderate sedation.
Hypothesis: We hypothesized that we could safely perform ASD closure without GA if we appropriately selected ICE or TEE for the imaging guidance.
Methods: Prior to transcatheter ASD closure, all patients underwent diagnostic TEE by using intravenous anesthesia. We selected TEE, ICE (AcuNav, Biosense Webster), or combined both as a guidance, depending on the anatomic ASD characteristics and the tolerability of TEE under moderate sedation. TEE and both TEE and ICE guidance group were performed under moderate sedation. Anatomic differences were retrospectively analyzed in the consecutive 116 patients who underwent ASD closure without GA.
Results: In ICE group, defect size was smallest and anyone had neither multiple defects nor malalignment, i.e. the gap between septum primum and septum secundum. Deficiency of lower side rim (<5 mm) and hypermobile rim (excursion ≥10 mm, mainly posterior margin) were more frequent in TEE+ICE group (Table). Procedures were successfully completed in all except one in whom TEE guided closure was attempted for the defect with broad superior rim deficiency. There were no major complications.
Conclusions: ASD closure without GA can be performed under simple ICE guidance in patients with single and relatively small defect. In the selected patients who have anatomically more complicated ASD and enough TEE tolerability, it can be performed under TEE or TEE combined with ICE guidance.
Author Disclosures: M. Yamano: None. T. Yamano: None. T. Nakamura: None. N. Nakanishi: None. K. Zen: None. H. Shiraishi: None. T. Shirayama: None. S. Matoba: None.
- © 2016 by American Heart Association, Inc.