Transcatheter closure of secundum atrial septal defect in adult and paediatric population without transoesophageal echocardiography/general anaesthesia

Background Transcatheter device closure is the preferred therapeutic option for secundum ASDs. Standard practice of utilizing transoesophageal echocardiography guidance, requires general anaesthesia which increases the cost, procedural duration, ICU stay, total hospital stays at risk of oesophageal injury and complications of GA. Transthoracic echocardiography is an excellent alternative with comparable efficacy as shown by many studies in pediatric population. Objective To assess and analyze the safety and efficacy of TTE-guided device closure of OS-ASD in all comer population irrespective of age, weight, defect size. Methods Patients who underwent device closure between March 2017-December 2025 were enrolled. All procedures were performed under local anesthesia (adults) and conscious sedation (children). Device was placed under fluoroscopy guidance, position confirmed on TTE. Procedural success, device: defect ratio, procedural time, fluoroscopy time, complications, ICU/hospital stay duration were analyzed and compared with our own experience of 125 patients of TEE-guided ASD closure (practiced before 2017). Results 571 patients underwent TTE-guided device closure. Procedure success was 97.7% with acceptable risk of major complications. Six (1.1%) had embolization into pulmonary artery, successfully operated surgically. Two (0.35%) had tamponade requiring drainage. In 15 (2.6%) patients, device could not be deployed despite multiple attempts and approaches. All unsuccessful procedures had a defect size of > 34mm and deficient IVC rim along with another short (other than aortic) rim. Findings were compared with our own previous experience of TOE guided closure (practised before 2017). Compared to TOE group, TTE group had significantly lower total procedural duration (75 ± 4 vs. 28.2 ± 2.5 min; p < 0.01), intensive care unit stay (24 ± 10 vs. 16.7± 3.1h; p < 0.01), and hospital (48±12 vs. 37.4± 3.5h; p < 0.01) stay duration. Fluoroscopic time was similar in both. There was no mortality in either group. Major complications were comparable, TTE-guided group had less post-procedure complications of vomiting and headache. Additional findings of less pre-procedure fasting duration and early commencement of post procedure oral intake were noted in TTE group. Conclusion TTE-guided device closure of OS-ASD is safe and feasible in all-comer population in experienced hands. It can negate the use of TEE in most unless poor echo’ window. It reduces the procedural duration; hospital stay and total cost apart from complications of GA/TOE.