title: Five-year follow-up of transcatheter intracardiac echocardiography-assisted closure of interatrial shunts.
abstract: OBJECTIVE
  We sought to prospectively evaluate long-term follow-up results of intracardiac echocardiography-aided transcatheter closure of interatrial shunts in adults.
  
  
  BACKGROUND
  Intracardiac echocardiography improves the safety and effectiveness of transcatheter device-based closure of interatrial shunts, but its impact on long-term follow-up is unknown.
  
  
  METHODS
  Over a 5-year period, we prospectively enrolled 258 consecutive patients (mean age 48 ± 19.1 years, 169 females) who had been referred to our centre for catheter-based closure of interatrial shunts. All patients were screened with transesophageal echocardiography before the operation. Eligible patients underwent intracardiac echocardiography study and attempted closure.
  
  
  RESULTS
  After intracardiac echocardiography study and measurements, 18 patients did not proceed to transcatheter closure due to unsuitable rims, atrial myxoma not diagnosed by preoperative transesophageal echocardiography or inaccurate transesophageal echocardiography measurement of defects more than 40 mm. The remaining 240 patients underwent transcatheter closure: transesophageal echocardiography-planned device type and size were modified in 108 patients (45%). Rates of procedural success, predischarge occlusion and complication were 100%, 94.2% and 5%, respectively. On mean follow-up of 65 ± 15.3 months, the follow-up occlusion rate was 96.5%. There were no cases of aortic/atrial erosion, device thrombosis or atrioventricular valve inferences.
  
  
  CONCLUSIONS
  Intracardiac echocardiography-guided interatrial shunt transcatheter closure is safe and effective and appears to have excellent long-term results, potentially minimizing the complications resulting from incorrect device selection and sizing.
authors.affiliation: Department of Cardiac Surgery, University of Verona Medical School, Verona, Italy. jackyheart@libero.it
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rigatelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Dell'Avvocata
authors.forename: Paolo
authors.initials: P
authors.lastname: Cardaioli
authors.forename: Massimo
authors.initials: M
authors.lastname: Giordan
authors.forename: Gabriele
authors.initials: G
authors.lastname: Braggion
authors.forename: Silvio
authors.initials: S
authors.lastname: Aggio
authors.forename: Loris
authors.initials: L
authors.lastname: Roncon
authors.forename: Carol
authors.initials: C
authors.lastname: Chen-Scarabelli
authors.forename: Tiziano M
authors.initials: TM
authors.lastname: Scarabelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D016009:Chi-Square Distribution; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000628:therapy*; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D055989:Septal Occluder Device; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional