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September 12, 2026Catheterization and Cardiovascular Interventions

Identifying a Favorable Morphological Profile for Transcatheter Atrial Septal Defect Closure in Patients With Deficient Posteroinferior Rims

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Why the study?

Transcatheter closure of secundum ASDs with a deficient posteroinferior rim is challenging due to technical failure risk, warranting exploration of morphological features tied to procedural success.

Do echocardiographic indices (defect-to-septal ratio and defect-to-left atrial volume ratio) predict procedural success in patients with deficient posteroinferior rims undergoing transcatheter ASD closure?

Population

34 patients with PI rim deficiency undergoing transcatheter closure attempts

Design

Retrospective study

Key result

Fulfilling at least one low-risk morphological criterion (DSR < 61.9% or DLAR < 1.3 mm/mL) identified a highly favorable cohort for transcatheter ASD closure, yielding a 100% procedural success rate.

Authors

NSNaka SaitoSSS ShirakiNKNao Koizumi

Discussion

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Overview

May identify favorable transcatheter ASD closure candidates via morphology; hypothesis-generating and requires prospective validation.

Key Points

  • To identify morphological characteristics and cut-off values on echocardiography associated with successful transcatheter closure in patients with secundum atrial septal defects and deficient posteroinferior rims.
  • Analyzed retrospective data from 34 patients with posteroinferior rim deficiency who underwent transcatheter defect closure attempts.
  • Calculated receiver operating characteristic curves to evaluate defect-to-septal ratio (DSR) and defect-to-left atrial volume ratio (DLAR) individually and in combination.
  • Procedural success occurred in 85% (29/34) of patients, with technical failure observed in 15% (5/34).
  • Cut-off values predictive of technical failure were identified as DSR ≥ 61.9% and DLAR ≥ 1.3 mm/mL.
  • Meeting at least one low-risk criterion (DSR < 61.9% or DLAR < 1.3 mm/mL) yielded a 100% (23/23) procedural success rate and an overall diagnostic accuracy of 82%.

Study Design

Type

Observational (n=34)

Structured PICO

Do echocardiographic indices (defect-to-septal ratio and defect-to-left atrial volume ratio) predict procedural success in patients with deficient posteroinferior rims undergoing transcatheter ASD closure?

P
Population
34 patients with secundum atrial septal defects and posteroinferior rim deficiency who underwent transcatheter closure attempts.
E
Exposure
Transcatheter closure of secundum atrial septal defects (ASDs)
O
Outcome
Procedural success

Combining defect-to-septal ratio and defect-to-left atrial volume ratio provides a practical framework for risk stratification and predicting procedural success in transcatheter ASD closure for patients with deficient posteroinferior rims.

Limitations

  • Exploratory cut-offs remain hypothesis-generating

Cite This Study

Saito et al. (2026) conducted an observational in Secundum atrial septal defects (ASDs) with a deficient posteroinferior (PI) rim (n=34). Low-risk morphological profile (DSR < 61.9% or DLAR < 1.3 mm/mL) was evaluated on Procedural success. Fulfilling at least one low-risk morphological criterion (DSR < 61.9% or DLAR < 1.3 mm/mL) identified a highly favorable cohort for transcatheter ASD closure, yielding a 100% procedural success rate.

synapsesocial.com/papers/6aa51ee4327956e4761f8df3https://doi.org/10.1002/ccd.70873
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