title: Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients.
abstract: BACKGROUND
  Interventional closure of atrial septal defects (ASDs) with a transcatheter device is the preferred strategy in children and adults. This procedure has been proven in numerous studies, but X-ray and contrast agent exposure is still a major side effect. The aim of this study was to clarify whether the interventional closure of ASDs is possible and safe if it is guided by transesophageal echocardiography (TEE) alone.
  
  
  RESULTS
  We retrospectively selected and studied pediatric and adult patients with interventional closure of ASDs at the Deutsches Herzzentrum Berlin (DHZB) without fluoroscopy between 1999 and 2010. We included 330 out of 1,605 patients; 254 had an ASD II, 30 a PFO and 46 multiperforated atrial septum. Median age was 8.92 (0.96-76.3) years and median body weight 32.6 (8.3-156) kg. Median stretched defect size was 13 (5-29) mm. Median procedure time was 50 (20-170) min. Closure was performed in the majority of patients with the Amplatzer(®) septal occluder or Amplatzer(®) PFO occluder. The procedure succeeded in 98.2 % of cases and closure rate was 94.9 % after 48 h. Complication rate was low and procedure time was similar to that necessary with studies using fluoroscopy.
  
  
  CONCLUSIONS
  Interventional closure of ASDs is safe and effective if guided with TEE alone. The results can compete with those with the use of fluoroscopy. TEE-guided closure of ASD should be considered in more catheter laboratories to avoid unnecessary radiation exposure for the patient and the examiner.
authors.affiliation: Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. sschubert@dhzb.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Schubert
authors.forename: Sarah
authors.initials: S
authors.lastname: Kainz
authors.forename: Björn
authors.initials: B
authors.lastname: Peters
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Peter
authors.initials: P
authors.lastname: Ewert
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult