P336 Echocardiography guiding without floroscopy transcatheter ASD closure: Single center experience in indonesia
Authors: Ariani R , Prakoso R , Kuncoro A S , Soesanto A M , Rudiktyo E , Kurniawati Y , Siagian S N 
Published: January 2020

Abstract

Background
Transcathether closure of Atrial Septal Defect (ASD) has become the first choice for most cases of secundum type of ASD worldwide with very good successful rate and low complication rate. However, the risk of radiation exposure to both patient and operator has gain increasing awareness due to its long term side effect. There is very limited data on transcathether ASD closure using only echocardiography without fluoroscopy.

Purpose
This study sought to evaluate feasibility, safety and effectiveness of transcatheter closure of atrial septal defects using echocardiography only without fluoroscopy in tertiary heart center in Jakarta Indonesia

Methods
We collected data from July 2018 to May 2019 of patients with secundum ASD underwent transcathether ASD closure using only echocardiography without fluoroscopy in tertiary heart center in Jakarta-Indonesia. All cooperative patient weighed &gt; 25 kg has underwent pre-procedural 2D/3D TEE evaluation to evaluate suitability for device closure. Patient who do not fulfill above criteria will be evaluated at cath lab just before proceduel and will be excluded if TEE evaluation revealed not suitable for device closure. 2D TEE was used during transcathether closure guiding. In direct closure delivery sheath was guided into left upper pulmonary vein, right upper pulmonary vein, or in left atriumfor deployment. For patient suspected had coexsisting pulmonary hypertension, non flouoscopic right heart catheterization was done. Position of catheter was also confirmed by pressure waveform monitoring.

Results
There were 67 patients with attempted zero fluoroscopy technique, of which 97% (67 patients) were successful. In failed group, one patient had poor TEE window, and one patient had LA isomerism so transjugular approach was used and we had difficulty to guide interventionist to maneuver the cathether. To these groups, transcathether closure was switched to fluoroscopy methods and device susccesfully implanted in both cases. Of the success group, There were 12 male and 53 female, age ranging from 2-62 yo (median 29 yo). Median size of the defect was 20 mm (min-max : 9-33 mm), with median size device implanted was 26 (min-max: 12-42 mm). There were 14 patients underwent pre right heart catetherization before procedure with pulmonary resistance index dan PVR/SVR ratio acceptable for closure in all patients. There is difference in mean procedure duration in groups with direct closure vs pre-closure right heart cathetherization, though not reach statistically significant difference (38 + 17 min vs 55 + 29 min, p = 0.06). In majority of cases, delivery sheath was position in left upper pulmonary vein (69%, 45 patients). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the the procedure.

Conclusion
Percutaneous transcatheter ASD closure completely guided by TEE is a feasible and safe procedure.