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Objective <p>To investigate the procedural approach and clinical efficacy of transcatheter closure of secundum atrial septal defect (ASD) via the femoral vein under echocardiographic guidance in pediatric patients.</p> Method <p>A total of 460 children (181 males and 279 females) diagnosed with secundum ASD who underwent percutaneous interventional closure at Beijing Children’s Hospital from January 2020 to November 2025 were enrolled in this study. The patients had a mean age of 4.18 ± 1.45 years (range, 2.1–17.0 years) and a mean body weight of 22.05 ± 8.97&#xa0;kg (range, 9.8–63.0&#xa0;kg). Among them, 411 cases presented with a solitary central secundum ASD with a defect diameter of 5–25&#xa0;mm, and 49 cases had fenestrated ASD with a shunt range of 11–22&#xa0;mm as measured by echocardiography. All patients had normal cardiac function without other intracardiac malformations, while 23 cases were complicated with extracardiac malformations. ASD closure was performed under transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) guidance.</p> Result <p>Of the 460 interventional occlusion procedures, 445 were successfully completed under pure echocardiographic guidance. Echocardiographic guidance failed in 15 cases, and successful occlusion was ultimately achieved with the pulmonary vein approach assisted by X‑ray. The mean procedural time (from anesthesia induction to sheath removal) was 18.25 ± 9.82&#xa0;min (range, 15–40&#xa0;min), and the size of the occluders used ranged from 10 to 30&#xa0;mm. All procedures were uneventful, with no complications including vascular injury, cardiac perforation, occluder dislodgement, or severe arrhythmia observed intraoperatively. Residual shunts were detected in 8 patients with fenestrated ASD postoperatively; among these, the shunts resolved in 6 cases at 1‑month follow‑up and persisted in 2 cases without aggravation. The average postoperative hospitalization stay was 2.2 days. Serial echocardiographic and electrocardiographic follow‑ups at 1, 3, 6 and 12 months postoperatively revealed normal findings in all patients.</p> Conclusion <p>Echocardiography‑guided percutaneous ASD closure via the femoral vein is a minimally invasive, radiation‑free interventional procedure that is safe and feasible for the treatment of secundum ASD in children, and thus worthy of clinical promotion.</p>

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Clinical study on echocardiography-guided percutaneous closure of atrial septal defect

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Yang Yang,
  • Zhenyu Lv,
  • Zhiyuan Wang,
  • Yanyan Xiao

摘要

Objective

To investigate the procedural approach and clinical efficacy of transcatheter closure of secundum atrial septal defect (ASD) via the femoral vein under echocardiographic guidance in pediatric patients.

Method

A total of 460 children (181 males and 279 females) diagnosed with secundum ASD who underwent percutaneous interventional closure at Beijing Children’s Hospital from January 2020 to November 2025 were enrolled in this study. The patients had a mean age of 4.18 ± 1.45 years (range, 2.1–17.0 years) and a mean body weight of 22.05 ± 8.97 kg (range, 9.8–63.0 kg). Among them, 411 cases presented with a solitary central secundum ASD with a defect diameter of 5–25 mm, and 49 cases had fenestrated ASD with a shunt range of 11–22 mm as measured by echocardiography. All patients had normal cardiac function without other intracardiac malformations, while 23 cases were complicated with extracardiac malformations. ASD closure was performed under transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) guidance.

Result

Of the 460 interventional occlusion procedures, 445 were successfully completed under pure echocardiographic guidance. Echocardiographic guidance failed in 15 cases, and successful occlusion was ultimately achieved with the pulmonary vein approach assisted by X‑ray. The mean procedural time (from anesthesia induction to sheath removal) was 18.25 ± 9.82 min (range, 15–40 min), and the size of the occluders used ranged from 10 to 30 mm. All procedures were uneventful, with no complications including vascular injury, cardiac perforation, occluder dislodgement, or severe arrhythmia observed intraoperatively. Residual shunts were detected in 8 patients with fenestrated ASD postoperatively; among these, the shunts resolved in 6 cases at 1‑month follow‑up and persisted in 2 cases without aggravation. The average postoperative hospitalization stay was 2.2 days. Serial echocardiographic and electrocardiographic follow‑ups at 1, 3, 6 and 12 months postoperatively revealed normal findings in all patients.

Conclusion

Echocardiography‑guided percutaneous ASD closure via the femoral vein is a minimally invasive, radiation‑free interventional procedure that is safe and feasible for the treatment of secundum ASD in children, and thus worthy of clinical promotion.