TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECTS WITHOUT FLUOROSCOPY: A SINGLE CENTER EXPERIENCE IN INDONESIA

Background
Transcatheter closure of atrial septal defect (ASD) is the preferred treatment with good efficacy and minimal complication. However, the risk of radiation exposure in certain population is of more and more concern. A novel fluoroscopy-free technique has been introduced but the evidence remains lacking. This study aims to evaluate the efficacy and safety of transcatheter closure of ASD without fluoroscopy.

Methods
We retrospectively selected and studied patients with transcatheter closure of ASD without fluoroscopy at the National Cardiovascular Center Harapan Kita, Jakarta-Indonesia between July 2018 to December 2018. The cardiac catheterization without fluoroscopy was performed before the procedure in several patients with high probability of pulmonary hypertension based on previous examination.

Results
We included 29 patients with isolated secundum ASD who underwent attempted transcatheter ASD closure with transesophageal echocardiography guidance only. Seven of them underwent cardiac catheterization and subsequent transcatheter closure. Mean age was 25.2 (2 - 55.7) years and mean body weight 43.5 (10-71) kg. ASD were successfully closed without fluoroscopy technique in 26 patients (90%). Two of them were pregnant (24 and 17 weeks of gestation). Overall procedure time ranged from 18 to 64 minutes (mean 41.7 min). There were no cardiac death related to procedure. During study, there was one case with transient ST elevation and bradycardia. No intervention-related complication was observed to the fetus.

Conclusions
Transcatheter closure of ASDs without fluoroscopy is safe and effective, with comparable procedural time with fluoroscopic technique.