Verschluss eines vorhofseptumdefekts ohne chirurgie und ohne rontgenstrahlen

Surgical closure of atrial septal defects can nowadays be performed without preoperative cardiac catheterization. For a transcatheter closure, however, x-ray exposure has been indispensable. We report a closure of an atrial septal defect under transesophageal echocardiography without fluoroscopy. A nine year old girl with an 11 mm atrial septal defect centrally located in the oval fossa was elected for transcatheter closure. Doppler-echocardiographically estimated Qp/Qs was 1.7: 1. Oxymetric Qp/Qs was 1.6: 1. After sedation with midazolam and propofol a diagnostic and interventional catheterization was performed without fluoroscopy. Under transesophageal echocardiography, the defect was sized over the wire with a 5F balloon catheter. The distance to the right pulmonary veins was 10 mm, to the coronary sinus and to the mitral valve 8 mm, respectively. Under transesophageal echocardiography, an 11 mm Amplatzer Septal Occluder was placed into the defect. Complete closure was achieved and no complications were encountered. We conclude that in selected cases with an atrial septal defect located in the oval fossa and clear-cut echocardiographic findings, an Amplatzer Septal Occluder can be safely deployed under echocardiographic guidance alone.