Vol. 30 No. 3 (2026)
CARDIOLOGY

Echocardiographic approach to transcatheter closure of atrial septal defects in children with a deficient or absent aortic rim: a retrospective analysis

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  • Mariya M. Kurako,
  • Mikhail A. Abramyan,
  • Tatyana Yu. Kulagina,
  • Manolis G. Pursanov
Mariya M. Kurako
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation
Mikhail A. Abramyan
Morozov Children’s City Clinical Hospital, Moscow, Russian Federatio; Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russian Federation
Tatyana Yu. Kulagina
Petrovsky National Research Center of Surgery, Moscow, Russian Federation
Manolis G. Pursanov
Morozov Children’s City Clinical Hospital, Moscow, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2026-3-49-56

Published 2026-10-21

Keywords

  • дефект межпредсердной перегородки; дефицит аортального края; окклюдер; техника stop-flow; эндоваскулярная хирургия; эрозия стенки предсердия и аорты; эхокардиография

How to Cite

Kurako, M. M. ., Abramyan, M. A. ., Kulagina, T. Y. ., & Pursanov, M. G. . (2026). Echocardiographic approach to transcatheter closure of atrial septal defects in children with a deficient or absent aortic rim: a retrospective analysis. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 30(3), 49–56. https://doi.org/10.21688/1681-3472-2026-3-49-56

Copyright (c) 2026 Kurako et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Introduction: Transcatheter closure of secundum atrial septal defects (ASDs) is
the standard of care. However, defects with a deficient or absent aortic rim remain technically challenging because of the risk of erosion of the aortic wall or atrial roof. Despite extensive international experience, techniques for the safe closure of such defects in children remain insufficiently studied in Russian clinical practice.

Objective: To develop and evaluate the effectiveness of a differentiated occludersizing algorithm based on comprehensive echocardiographic imaging to minimize the risks of transcatheter ASD closure in children with a deficient aortic rim.

Methods: A retrospective analysis was performed in 265 children with an isolated deficient or completely absent aortic rim. Transthoracic (TTE) and transesophageal echocardiography (TEE) were the principal imaging modalities used for monitoring at all stages of the procedure. A personalized approach to device sizing was applied: in patients with firm rims, device size was determined using echocardiography with color Doppler mapping; in patients with thin rims, the stop-flow technique was used. Particular attention was paid to the device-to-body-weight ratio (device diameter/ body weight).

Results: The mean device-to-body-weight ratio in the study group was 0.88, which helped avoid excessive pressure on cardiac structures. Implementation of the differentiated algorithm, involving selection of an occluder 2 mm smaller to 2 mm larger than the measured size depending on the echocardiographic appearance of the rims, resulted in a high technical success rate. During the entire follow-up period (median, 38 months; interquartile range [IQR], 24–52 months; range, 6–84 months), there were no cases of aortic erosion or other life-threatening complications.

Conclusion: Transcatheter ASD closure in children with a deficient aortic rim is a safe procedure provided that the imaging protocol is strictly followed and the occluder is appropriately sized. The proposed algorithm and monitoring of the device-to-bodyweight ratio minimize mechanical stress on the aortic root and provide excellent clinical outcomes.

Received 17 March 2026. Revised 17 June 2026. Accepted 23 June 2026.

Funding
The study did not have sponsorship.

Conflict of interest
The authors declare no conflicts of interest.

Contribution of the authors
Conception and study design: M.M. Kurako

Data collection and analysis: M.M. Kurako, M.A. Abramyan, M.G. Pursanov

Statistical analysis: M.M. Kurako

Drafting the article: M.M. Kurako, M.A. Abramyan

Critical revision of the article: T.Yu. Kulagina, M.G. Pursanov

Final approval of the version to be published: all authors

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