Article Text

Intracardiac versus transoesophageal echocardiography guided closure of patent foramen ovale and atrial septal defects: prospective 5-year single-centre experience
  1. KN Asrress,
  2. RG Schrale,
  3. N Wilson,
  4. O Ormerod,
  5. ARJ Mitchell
  1. John Radcliffe Hospital, Oxford, UK


Introduction Imaging to guide percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) has traditionally required transoesophageal echocardiography (TOE) with general anaesthesia. The development of intracardiac echocardiography (ICE) allows these procedures to be performed under local anaesthesia, obviating the need for endotracheal intubation and general anaesthesia. We set out to evaluate prospectively the effect of ICE on the success and efficiency of PFO and ASD closure.

Methods Data on all adult patients undergoing percutaneous PFO and ASD closure were collected prospectively between 2003 and 2008. Allocation to echocardiographic technique was non-random and determined by the availability of anaesthetic and cardiology staff, initial ICE probe availability and relative contraindication to general anaesthesia. Procedure time, fluoroscopy time, radiation dose, device deployment success rate, procedural complications, hospital stay length and interatrial communication closure at 3 months were compared between the two imaging modalities.

Results 210 consecutive patients underwent percutaneous interatrial defect closure over the study period, 55 (26%) with TOE and 155 (74%) using ICE. Baseline characteristics of the TOE and ICE groups were similar (age 45.3 ± 15.5 vs 47.9 ± 13.6 years, p = 0.415; male 36% vs 42%, p = 0.524; body surface area 1.81 ± 0.27 vs 1.90 ± 0.26 m2, p = 0.110; interatrial defect size (for ASD) 19.8 ± 8.9 vs 18.2 ± 7.9 mm, p = 0.458). Procedural time (not including induction and recovery from general anaesthesia; 50 ± 21 vs 42 ± 18 minutes, p = 0.007), fluoroscopy time (8.0 ± 6.0 vs 5.4 ± 4.0 minutes, p<0.0001), radiation dose (1350 ± 1626 vs 714 ± 1017 cGy/cm2, p<0.0001) and inpatient stay 1.8 ± 0.9 vs 1.0 ± 3.3 days, p<0.0001) were significantly reduced using ICE. There were no differences in the device deployment success rate (94% vs 95%, p = 0.724) and interatrial communication closure at 3 months (96% vs 93%, p = 0.722).

Conclusions During percutaneous closure of interatrial defects, ICE avoids the risks and inconvenience of general anaesthesia and is associated with significantly reduced procedure times, radiation doses and inpatient stay compared with TOE, without compromising procedure success.

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