Transcatheter atrial septal defect closure guided by colour flow Doppler.

OBJECTIVES: To describe and assess the use of the maximum colour flow diameter (CFDmax) in guiding transcatheter closure of atrial septal defects (ASDs) and compare it with the standard balloon sizing method.

BACKGROUND: Balloon sizing of ASDs has been the standard method of assessing the size of ASDs and selecting a closure device. However, overestimation of the defect by stretching it may result in complications such as erosion of the atrial wall or aortic root, particularly in the presence of a deficient aortic rim and the long-term effects of oversized defects are unknown.

METHODS: Retrospective and prospective assessment of 115 consecutive patients who underwent ASD closure during three different time periods, when change in local practice occurred. Fifty patients underwent ASD closure with balloon sizing (period A), 15 with the aid of balloon sizing and additional estimation of the CFDmax (period B) and 50 with sole assessment of the CFDmax (period C).

RESULTS: The mean difference between the device used and the 2D defect size decreased from 6.9 to 5.1mm (p<0.01) and the percentage of device oversizing decreased from 38% to 31%. The complication rate decreased from 14% to 2%, (p=0.03), whilst the procedure and screening times decreased from 70 to 43min, (p<0.001) and 14.2 to 8.4min, (p<0.001), respectively.

CONCLUSIONS: Transcatheter closure of ASDs guided solely by the CFDmax is feasible and safe and results in decreased procedure and screening times, whilst maintaining a low complication rate.