Percutaneous atrial septal defect closure using transesophageal echocardiography without fluoroscopy in a pregnant woman: a case report
Abstract
Transcatheter closure is the treatment of choice for atrial septal defect (ASD); it has good efficacy and minimal complications. However, this approach in a pregnant woman is limited due to the risk of radiation exposure. A novel fluoroscopy-free technique has been introduced to reduce x-ray exposure. This case reported the experience of an ASD transcatheter closure in a pregnant woman without fluoroscopy guidance. To the best of our knowledge, this is the first successful fluoroscopy-free technique for transcatheter closure in Indonesia. The case is a 26-year-old primigravida at 26 weeks gestational age with secundum ASD and pulmonary hypertension. Transcatheter closure was successfully performed with a Cera ASD occluder (Lifetech Scientific Corporation, China) no. 28 mm guided by transesophageal echocardiography. During the procedure, transient supraventricular tachycardia was developed. There were no other major or minor periprocedural complications. ASD transcatheter closure in a pregnant woman without fluoroscopy is feasible, safe, and effective.
References
Schubert S, Kainz S, Peters B, Berger F, Ewert P. Interventional closure of atrial septal defects without fluoroscopy in adult and pediatric patients. Clin Res Cardiol. 2012;101(9):691-700. https://doi.org/10.1007/s00392-012-0445-1
Ewert P, Berger F, Daehnert I, van Wees J, Gittermann M, Abdul-Khaliq H, et al. Transcatheter closure of atrial septal defects without fluoroscopy: feasibility of a new method. Circulation. 2000;101(8):847-9. https://doi.org/10.1161/01.CIR.101.8.847
Yang Y, Zhang W, Wu Q, Gao L, Jin W, Zhao T. Transcatheter closure of atrial septal defects without fluoroscopy: a well-established procedure for alternative use in children. EuroIntervention. 2016;12(5):e652-7. https://doi.org/10.4244/EIJV12I5A106
Cao H, Chen Q, Zhang GC, Chen LW, Qiu ZH, Lu H. Percutaneous device closure of atrial septal defect with totally transthoracic echocardiography guide, without x-ray machine. Medicine. 2016;95(44):e5256. https://doi.org/10.1097/MD.0000000000005256
Pan XB, Ou-Yang WB, Pang KJ, Zhang FW, Wang SZ, Liu Y, et al. Percutaneous closure of atrial septal defects under transthoracic echocardiography guidance without fluoroscopy or intubation in children. J Interv Cardiol. 2015;28(4):390-5. https://doi.org/10.1111/joic.12214
Zanjani KS, Zeinaloo A, Malekan-Rad E, Kiani A, Bagheri MM. Transcatheter atrial septal defect closure under transthorasic echocardiography in children. Iran J Pediatr. 2011;21(4):473-8. http://dx.doi.org/10.5812/ijp.3906
Jia Y, Meng X, Li Y, Xu C, Zeng W, Jiao Y, et al. Percutaneous occluder device closure through femoral vein guidance by transthoracic echocardiography in adult atrial septal defect patients. J Thorac Dis. 2018;10(3):1460-7. https://doi.org/10.21037/jtd.2018.02.06
Yong G, Khairy P, De Guise P, Dore A, Marcotte F, Mercier LA, et al. Pulmonary arterial hypertension in patients with transcatheter closure of secundum atrial septal defects: a longitudinal study. Circ Cardiovasc Interv. 2009;2(5):455-62. https://doi.org/10.1161/CIRCINTERVENTIONS.108.826560
Acar P, Massabuau P, Elbaz M. Real-time 3D transoesophageal echocardiography for guiding Amplatzer septal occluder device deployment in an adult patient with atrial septal defect. Eur J Echocardiogr. 2008;9(6):822-3. https://doi.org/10.1093/ejechocard/jen178
D'Alto M, Mahadevan VS. Pulmonary arterial hypertension associated with congenital heart disease. Eur Respir Rev. 2012;21(126):328-37. https://doi.org/10.1183/09059180.00004712
Ewert P, Daehnert I, Berger F, Kaestner A, Krings G, Vogel M, et al. Transcatheter closure of atrial septal defects under echocardiographic guidance without x-ray: initial experiences. Cardiol Young. 1999;9(2):136-40. https://doi.org/10.1017/S1047951100008349
Copyright (c) 2020 Radityo Prakoso, Rina Ariani, Oktavia Lilyasari, Yovi Kurniawati, Sisca Natalia Siagian, Indriwanto Sakidjan, Poppy Soerwanti Roebiono, Anna Ulfah Rahajoe, Olfi Lelya, Aditya Agita Sembiring, Ganesja Moelia Harimurti
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
