title: Efficacy and Safety of Transthoracic Echocardiography Alone in Transcatheter Closure of Secundum-Type Atrial Septal Defects in Adults.
abstract: BACKGROUND
  On-site transthoracic echocardiography (TTE) to guide the transcutaneous closure of secundum-type atrial septal defects (ASDs) in the catheterization laboratory remains unclear, especially in adults.
  
  
  METHODS
  Between 2005 and 2012, a total of 82 adults underwent transcutaneous closure of ASDs. The initial 15 cases underwent the procedure with both on-site transesophageal echocardiography (TEE) and TTE monitoring. Since January 2008, a total of 67 patients underwent on-site TTE alone to guide the procedure.
  
  
  RESULTS
  Among the 82 adult patients who underwent a transcutaneous closure of the secundum-type ASD procedure, all had successful closure of the defects, and no periprocedural adverse complications occurred. No statistical significance was observed in the successful complete shunt closure rate between the TEE plus TTE and TTE groups during sequential follow-up (postprocedure 24 hour [87% vs. 92%],1 month [93% vs. 95%], 3 month [93% vs. 97%], and 12 month [93% vs. 97%], P > 0.05, respectively) nor was a significant difference observed between the two groups, including decreased right ventricular dimension (29.5 ± 3.3 vs. 32.0 ± 4.9 mm, 26.5 ± 3.0 vs. 28.7 ± 4.6 mm, 26.2 ± 3.1 vs. 28.2 ± 4.8 mm, and 25.6 ± 2.8 vs. 27.7 ± 4.7 mm, P > 0.05, respectively) or increased left ventricular end-diastolic dimension (41.1 ± 2.0 vs. 42.6 ± 3.0 mm, 44.3 ± 2.7 vs. 45.5 ± 3.1 mm, 44.2 ± 2.8 vs. 45.4 ± 3.1 mm, 44.9 ± 2.7 vs. 45.8 ± 2.6 mm, P > 0.05, respectively) before the procedure, and at the 3-, 6-, and 12-month follow-up evaluations.
  
  
  CONCLUSIONS
  This study showed that TTE guidance alone may be considered efficacious and safe as TEE during a transcutaneous ASD occlusion procedure in select adults.
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Ding
authors.affiliation: Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan.
authors.forename: Jia-Kan
authors.initials: JK
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan.
authors.forename: Chang-Chyi
authors.initials: CC
authors.lastname: Lin
authors.affiliation: State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Yong-Jian
authors.initials: YJ
authors.lastname: Wu
authors.affiliation: Department of Pediatrics, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Kai-Sheng
authors.initials: KS
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D055989:Septal Occluder Device / Q000706:statistics & numerical data*; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: interventional cardiac catheterization; percutaneous transcatheter closure; transthoracic echocardiography