271: Intracardiac echocardiographic guidance is efficient for transcatheter closure of atrial septal defect in an unselected patient population

Background Intracardiac echocardiography (ICE) is an alternative to transesophageal echocardiography (TEE) for transcatheter closure of atrial septal defect (ASD). However, studies on ICE guidance generally include a majority of patent foramen ovale (PFOs) and only few ASDs without rim deficiency. Our aim was to assess transcatheter closure of ASDs under ICE guidance in an unselected patient population. Method From January 2006 to January 2012 in our institution, all the ASDs in the adult population were closed percutaneously under ICE guidance. During this period, 93 patients (34 males, 59 females, mean age 46,9 years) had transcatheter ASD closure with Amplatzer devices under local anesthesia and ICE guidance. All patients had routine TEE before catheterization. Results Fifteen patients (13,9%) had deficient rim(s) other than the antero-superior. The median ASD diameter by TEE and device size was 20 and 26 mm, respectively. Ninety cases (96,7%) were successfully closed. Three cases failed because of insufficient rims and/ or defect size superior to 40 mm. Minor and transient complications occurred in 10 patients (9,6%). Three patients experienced a major complication with favorable outcome: one arterial femoral wall tear treated by embolization, one blood transfusion for a groin hematoma and one retroperitoneal hematoma. The only risk factor for failure to close the ASD was deficient rims (p=0,05), whereas the size of the ASD was a risk factor for major complications (p=0,03). The correlation coefficient between the size of the ASD with TEE and ICE was 0.887. Conclusion In an unselected patient population, ICE provides a safe and efficient guidance for device closure of ASD, even for large defects with deficient rims.