Child's Health · Published 2026-06-24 · DOI 10.22141/2224-0551.21.4.2026.1960
Dafer Mahammad Hussein Etaij, Karrar Abdil Aziz Ali Beg, Nadia Abdulhussein Salih, Ahmed Abdullah Mezher, Ameer Isam Al-Aasem
Background. Transesophageal echocardiography (TEE) is the established imaging guide for transcatheter atrial septal defect (ASD) closure, yet it also carries significant drawbacks, including the need for general anesthesia in children, increased procedural costs, and contraindications in select patients. Although transthoracic echocardiography (TTE) is a noninvasive and readily available alternative, the degree of reliability with which it can guide device sizing and deployment is still poorly defined. The purpose was to evaluate the safety and efficacy of TTE-guided/performed transcatheter closure of secundum ASDs, and determine whether TTE-based measurements in conjunction with real-time echocardiographic assessment are reliable for selecting occluder size. Materials and methods. This is a prospective study of 89 patients (66 females; mean age 23 years; range 2.5–68) who underwent TTE-guided transcatheter secundum ASD closure at Al-Najaf Cardiac Centre, Iraq, from January 2023 to December 2025. The reference ASD size was the maximal ASD diameter measured on multiview TTE. In group A (n = 42, < 20 mm), TTE diameter ± 2–4 mm (15–20 %) of the measured defect size was considered, and in group B (n = 47, ≥ 20 mm), this allows a final device sizing of ± 5–7 mm (20–25 %) above the defect measurement. The primary endpoint was successful closure with the TTE-selected device (no residual shunt/no structural interference). Secondary endpoints included overall procedural success, complications, and fluoroscopy time. Results. Transcatheter closure was successful in 86/89 (96.6 %) patients overall, and the TTE-selected device was accurate in 81/89 (91.0 %) patients. Successful device selection was 95.2 % (40/42) in group A and 87.2 % (41/47) in group B (P > 0.05). Adequate rims predicted superior outcomes (94.9 .vs 63.6 % for deficient rims; P < 0.05). In group B, an upsize of 20–25 % was superior to an upsize of 15–20 % (91.1 vs. 70 %; P < 0.05). No patient died. Complications were minor and occurred in 12 patients (13.4 %) — transient arrhythmia (8), groin hematoma (2), and trivial residual shunt (2). Of the three, two with a deficient posteroinferior rim and one with a superior rim had to be referred for surgical evaluation. Conclusions. TTE provides safe, reliable, and cost-effective vguidance for transcatheter secundum ASD closure and accurate device sizing, especially when septal rims are adequate. For defects ≥ 20 mm, choosing a device 20–25 % larger than the TTE-measured diameter yields the best results.
Abstract from DOAJ. Public domain (CC0 1.0).
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Etaij, D., Beg, K., Salih, N., et al. (2026). Transthoracic echocardiography-guided transcatheter closure of secundum atrial septal defects: efficacy of TTE-based device sizing and procedural monitoring. Child's Health. https://doi.org/10.22141/2224-0551.21.4.2026.1960