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

Background. Intracardiac echocardiography (ICE) is rapidly becoming a necessary tool in the catheterisation laboratory. We sought to prospectively evaluate the effectiveness of ICE-aided transcatheter closure of interatrial shunts. Methods. In a prospective 10-year registry, we enrolled 378 patients (mean age 48±13.7 years, 214 females) who had been referred to three different centres for catheter-based closure of interatrial shunts. All patients were screened with transoesophageal echocardiography (TOE) before the operation. Eligible patients underwent ICE study with mechanical Ultra-ICE probe (Boston Scientific Corp, USA) and closure attempt. Results. After the ICE study and measurements, 23 patients did not proceed to transcatheter closure due to: unsuitable rims, atrial myxoma not diagnosed by pre-operative TOE, or inaccurate TOE measurement of defects more than 40 mm. The remaining 355 patients underwent transcatheter closure: TOE-planned device type and size were modified in 175 patients (49.3%). There were no cases of aortic or 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 minimising device size over and underestimation, and potential complications of balloon sizing and general anaesthesia.