The role of transesophageal echocardiography during catheter closure of ASD and VSD

Transcatheter closure has developed into a significant alternative for surgery in the treatment of atrial septal defects (ASDs). Before the choice can be made between the two treatment options, patients should be selected who have a septal defect that is suitable for catheter closure. Transthoracic echocardiography has proven to be unreliable in this respect. Therefore, a diagnostic transesophageal echocardiogram (TEE) is mandatory prior to an intervention session. In adults, this can be done during a routine outpatient clinic visit. In children, a TEE has to be done under general anesthesia. Therefore, it is practical to plan a diagnostic TEE under general anesthesia first, with the possibility of a subsequent catheter intervention in the same session. During the procedure, the role of TEE is to provide additional information to the fluoroscopy images that the interventional cardiologist is used to working with. TEE gives detailed information on the position of the catheter and the device in relation to vital intracardiac structures, like the atrioventricular valves, the pulmonary veins and, most important, the atrial septum itself. Good collaboration between the interventionalist and echocardiographer has proven to be beneficial for successful nonsurgical closure of ASDs. The role of transcatheter closure of ventricular septal defects is limited. Only defects for which surgical treatment is impossible or unattractive are thought to be candidates for transcatheter closure. TEE is helpful also in this procedure.