Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

Transcatheter device closure of secundum atrial septal defects (ASD) is the first-line method of repair when the anatomy is suitable given the lower morbidity rate in comparison to surgery (1,2). Over- or under-sized device increased the risk of complication (3). A careful assessment of ASD size, morphology and rims is the key-step for device selection. Trans-esophageal echocardiography (TEE) or intracardiac echocardiography (ICE) are widely used to guide the procedure (4,5). However, TEE use may lead to oropharyngeal and oesophageal traumas (6-8), and ICE is expensive and require an additional large venous access (9). Given a good echocardiographic window in children, transthoracic echocardiographic (TTE) guidance has been proposed (10-13). However this approach is not universally accepted (14,15) and most publications report either small or old series, always on selected patients (10-13). We aimed in this study to compare efficacy and safety of 2D-TTE versus 2D-TEE to guide percutaneous ASD closure in a large, unselected, consecutive pediatric population