STRUCTURAL HEART DISEASE Is it Safe to Close ASD with the Guidance of Transthoraxic Echocardiography in Pediatric Population “Ten Years’ Experience of a Single Center” ALI BAYKAN, OZGE PAMUKCU, ABDULLAH OZYURT, MUSTAFA ARGUN, SERTAC HANDEDAN ONAN, SADETTIN SEZER, KAZIM UZUM, and NAZMI NARIN From the Division of Pediatric Cardiology, Erciyes University School Of Medicine, Kayseri, Turkey Objective: Main purpose of this study is to emphasize the usage and safety of transthoracic echocardiography (TTE) in percutaneous atrial septal defect (ASD) closure in appropriate pediatric cases. Background: Nowadays, percutaneous closure is preferred as treatment modality for ASD in pediatric age group. Methods: Between the dates December 2003–August 2013; 340 patients whose ASD were closed included in this study. Physical examination, electrocardiogram, TTE were done before the procedure, at the 24th hour, 1st and 6th month after the procedure. After the 6th month, routine control was done annually. Transesophageal echocardiography (TEE) was performed in 184 cases with large, multifenestrated ASD and when TTE views were poor in quality. We selected the 201 patients whose ASD diameter between 10–20 mm and formed 2 homogeneous groups according to the type of echocardiography used (TEE or TTE) in order to compare the role of echocardiography. Results: The demographic features of patients of 2 groups were similar. There was not any statistically difference between ASD, balloon sizing diameters between the groups. No statistically significant difference in the success, complication, and residual shunt rates was found between the groups. Procedure, fluoroscopy time, and amount were significantly higher in TEE group. When hemodynamic variables except pulmonary blood flow to systemic blood flow (Qp/Qs; right–left atrium mean pressure, pulmonary vascular resistance, and peak-mean pulmonary arterial pressure) were compared, there was not statistically difference. Conclusion: TEE is an invasive procedure and requires general anesthesia, therefore, it should not be done routinely in ASD but only in selected cases. If the size and the anatomy of ASD is appropriate, TTE should be preferred primarily in percutaneous ASD closure. (J Interven Cardiol 2015;28:172–179) Introduction Natural history of atrial septal defect (ASD) is usually benign but the large ones when untreated may lead to congestive heart failure, recurrent lower respiratory tract infections, and by advancing ages, pulmonary vascular disease, atrial fibrillation risk increases. Before the advent of transcatheter proce- dures, surgery was the only treatment choice for ASD. As the technique of delivery and devices are improved, today catheterization is preferred. 1,2 In percutaneous ASD closure, accurate imaging of the anatomic features of ASD is critical for the case selection, planning, guidance during the procedure, and post-deployment evaluation. Echocardiography plays the major role in imaging. Up till now, transesophageal echocardiography (TEE) is accepted as the primary tool assisting for ASD closure but it is invasive, and general anesthesia with intubation is required for pediatric patients. 3 Transthoracic echo- cardiography (TTE) is easy to perform, cost effective, does not require general anesthesia, and intubation. Experienced pediatric cardiologist may gather suffi- cient information required for ASD. The purposes of the study were to (a) share 10 years experience of our center in percutaneous ASD closure, Address for reprints: Ozge Pamukcu, M.D., Division Pediatric Cardiology, Erciyes University School of Medicine, Kayseri, Turkey. Fax: 0903524375273; e-mail: ozgepamukcu2002@yahoo.com © 2015, Wiley Periodicals, Inc. DOI: 10.1111/joic.12197 172 Journal of Interventional Cardiology Vol. 28, No. 2, 2015