Ice-Assisted Transcatheter Closure of Interatrial Shunt: Ten-Year Follow-Up

Gianluca Rigatelli,, MD, PhD, Fabio Dell’Avvocata,MD, Massimo Giordan, MD, Beatrice Magro, Rn, Sabrina Osti, Rn, Paola Rafagnato, Rn, Antonella Tiribello, Rn, Lorella Tiberio, Claudia Buson, RN, Paolo Cardaioli, MD

Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy

Disclosure: No potential conflict of interest.
Citation: EMJ Int Cardiol.2013;1:43-49.


Background. Intracardiac echocardiography is rapidly becoming a necessary tool in the cath lab. We sought to prospectively evaluate the effectiveness of intracardiac echocardiography (ICE)-aided transcatheter closure of interatrial shunts.
Methods. In an prospective 10-year registry, we enrolled 378 patients (mean age 48 ±13.7 years, 214 females) who have been referred to three different centers for catheter-based closure of interatrial shunts. All patients were screened with transesophageal echocardiography before the operation. Eligible patients underwent ICE study with mechanical UltraIce probe (Boston Scientific Corp,USA) and closure attempt.
Results. After intracardiac echocardiography study and measurements, 23 patients did not proceed to transcatheter closure due to: unsuitable rims, atrial myxoma not diagnosed by preoperative transesophageal echocardiography, or inaccurate transesophageal echocardiography measurement of defects more than 40 millimeters. The remaining 355 patients underwent transcatheter closure: transesophageal echocardiography-planned device type and size were modified in 175 patients (49.3%). There were no cases of aortic/atrial erosion, device thrombosis, or atrioventricular valve inferences. Globally the rates of procedural success, pre-discharge occlusion, and major complications rate were: 99.1%, 93.3%, and 0%, respectively. On mean follow-up of 9.1 ±2.3 years, the follow-up occlusion rate was 98.7% with no long-term complications.
Conclusions. ICE-aided transcatheter closure of interatrial shunts appears to be safe and effective in adult patients thus eventually minimizing device size over- and under-estimation, and potential complications of balloon sizing and general anaesthesia.

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