Transcatheter intracardiac echocardiography-assisted closure of interatrial shunts: complications and midterm follow-up.

OBJECTIVE: It has been suggested that intracardiac echocardiography (ICE) improves the safety and effectiveness of transcatheter device-based closure of interatrial shunts, but the impact of this technique on midterm follow-up is unknown. We sought to prospectively evaluate midterm follow-up results of ICE-aided transcatheter closure of interatrial shunts in adults. METHODS: Over a 48-month period, we prospectively enrolled 140 consecutive patients (mean age 43 +/- 15. 5 years, 98 females) who had been referred to our center for catheter-based closure of interatrial shunts. All patients were screened with transesophageal echocardiography (TEE) before the operation. Patients who met the inclusion criteria underwent ICE study and attempted closure. Immediate success rates, predischarge occlusion rates, complication rates, as well as fluoroscopy and procedural times, patients' radiological exposure, midterm complication rates, and midterm occlusion rates were evaluated. RESULTS: One hundred patients out of 140 (71.4\%) underwent an attempt at transcatheter closure. After ICE study and measurements, the TEE-planned device type and size was changed in 31 patients with patent foramen ovale whereas the TEE-planned device size was changed in 41 patients with atrial septal defect (globally 72\%). Procedural success rate, predischarge occlusion rate, and complication rate were 99, 90.7, and 12\%, respectively. On mean follow-up of 36.6 +/- 14.8 months the follow-up occlusion rate was 96.5\%. No aortic erosion or device thrombosis was observed. CONCLUSIONS: ICE-guided interatrial shunt transcatheter closure is safe and effective and appears to have excellent midterm results thus avoiding the complications caused by device oversizing, such as aortic erosion and device thrombosis.