Percutaneous and Non-fluoroscopic Procedure for Atrial Septal Defect Closure, Patent Foramen Ovale Closure and Transcatheter Edge-to-edge Repair

Structural heart disease affects patients across all age groups and traditionally requires invasive open-heart surgery or percutaneous interventions with radiation exposure. Percutaneous and non-fluoroscopic (PAN) procedures enable non-thoracotomy, radiation-free treatment using echocardiographic guidance for structural heart interventions. This article examines the application of PAN procedures in atrial septal defect (ASD) closure, patent foramen ovale closure and transcatheter edge-to-edge repair (TEER). The most robust evidence for the use of the PAN procedure is in ASD closure, with Chinese studies reporting procedural success rates improving from 92–96.5% in early studies to 98–100% in recent studies. International validation from German, Iranian and Indonesian centres and a meta-analysis of eight studies confirm consistent success rates of 94–100% across diverse healthcare settings. The PAN procedure in the patent foramen ovale closure shows promising feasibility, with success rates of 95–100% and manageable learning curves requiring approximately 50 cases for proficiency. The PAN procedure has reportedly achieved high procedural success for TEER in small samples, although its use for TEER requires further validation. As a radiation-free approach, the PAN procedure offers significant advantages, including eliminating radiation exposure, enhanced accessibility in resource-limited settings and potential cost reductions.