GW24-e1282 A noninvasive sizing method to choose fitted atrial septal defect occluder by transthoracic echocardiography in adults with secundum atrial septal defects

Objectives In our clinical practice, we try to find a feasible method to size the hole of ASD by only 2D transthoracic echocardiography (2D-TTE). It should be more practical, less expensive and without pain. Methods Sixty-seven consecutive adult patients (26 males, 41 females, mean age 38.4 ± 8.5 years) were scheduled to have ASD device closure. Before that, we calculated the size of ASD by 2D transthoracic echocardiography (2D-TTE) through parasternal four chambers view, parasternal short axes view, apical four chambers view, subcostal four chambers view and subcostal two chambers view. The biggest size from the views would be chosen for ASD device closure. Meanwhile, we paid attention to the ASD margins, and we divided them to floppy margin group (n = 24) and firm margin group (n = 43). For the floppy margin patients, we would add 2 or 4 mm more than the 2D-TTE size for preparing ASD device size. And for the firm margin patient, we chose the same 2D-TTE size for ASD device size. Results The total successful ASD device closure rate was 94.0% (63/67). The average total trans-catheter ASD closure time was 42.3 ± 12.5 minutes. ASD device closure succeeded at the first time was: 40/43 (93.0%) in the firm margin group; 16/24 (66.7%) in the floppy margin group. For the rest patient whose ASD couldn’t be closed at the first time, we reduced the size 2–5 mm in the firm margin group, the rest 3 all got successful ASD device closed. As in the floppy margin group, there were 4 patients needed adding 4–6 mm to the 2D-TTE size and then their ASD device closed successfully. There were only 4 patients (6%) in floppy margin group couldn’t be ASD device closed. For average 1.4 years follow up, only 6 patients (9.5%) had some chest pain complain, but all the devices were stable. Conclusions With our experience, the sizing based on 2D-TTE could be used for ASD device selection. The multiple views of TTE should be used to calculate the biggest size of ASD. And the margins of the ASD hole also need to be considered.