Two-dimensional transthoracic echocardiography versus two-dimensional trans esophageal echocardiography for assessment of moderate to large atrial septal defects and the device size in pediatric patients before transcatheter closure

Atrial Septal Defects (ASDs) are a common type of congenital heart defect (CHD) in children. Accurate pre-procedural assessment is crucial for successful transcatheter closure. This study aims to compare ASD size and surrounding rims measurements from transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in pediatric patients undergoing transcatheter closure of ASDs, assess agreement between TTE and TEE measurements, and evaluate TTE’s potential as a first-line imaging modality for ASD assessment. This prospective cohort study was conducted on 50 pediatric patients with secundum ASD admitted for transcatheter device closure of ASD in Smouha University Hospital. Patients underwent TTE and TEE examinations before undergoing the procedure. ASD size and rim measurements (aortic, AV valve, SVC, IVC, posterior) were compared between modalities. Agreement was assessed using Bland-Altman analysis. TTE measurements yielded significantly larger values of ASD size compared to TEE (22.27 ± 8.64 mm vs. 14.93 ± 5.11 mm; p < 0.001). Significant differences were also observed in rim measurements for the AV valve, Aortic, Posterior, and IVC rims (p < 0.05), while SVC rim differences were not significant (p = 0.212). Despite mean differences, a strong positive correlation was discovered between TTE and TEE measurements of ASD size (rs = 0.963, p < 0.001). Bland-Altman analysis demonstrated good agreement with less than 5% of points falling outside the 95% limits of agreement. Procedural success was 100% with no residual shunts or complications at 24-hour follow-up. TTE was found to be reliable and cost-effective for evaluation of secundum ASDs, showing strong correlation with TEE. While TTE measurements were systematically larger, the agreement supports its use as a first-line modality for uncomplicated cases, while TEE remains valuable for detailed evaluation in complex scenarios.