Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
September 10, 2026 · via Europe PMC
Identifying a Favorable Morphological Profile for Transcatheter Atrial Septal Defect Closure in Patients With Deficient Posteroinferior Rims.
Saito N, Shiraki S, Koizumi N, Kato A, Wakamiya T, Ono S, Yanagi S, Ueda H.
AI summary — for doctors, generated from the abstract only
In a small study of patients with deficient posteroinferior rims, a challenging anatomic feature for atrial septal defect closure, combining two echocardiographic ratios comparing defect size to septum and to left atrial volume improved prediction of procedural success compared with either measure alone, though these cutoffs remain exploratory.
What was studied
A retrospective study of 34 patients with posteroinferior rim deficiency who underwent attempted transcatheter atrial septal defect closure, using statistical analysis to determine cutoff values for echocardiographic indices associated with procedural success versus technical failure.
Key findings
- Procedural success was achieved in 85% (29/34) of patients, with technical failure in 15% (5).
- Combining a defect-to-septal ratio with a defect-to-left-atrial-volume ratio significantly improved risk stratification for technical failure compared with the defect-to-septal ratio alone.
- Exploratory cutoff values for predicting technical failure were identified for both ratios.
Clinical relevance
This suggests that assessing the spatial mismatch between defect size and left atrial volume, not just defect size relative to the septum, provides a more practical framework for identifying patients with this type of rim deficiency who are good candidates for transcatheter closure versus those who may need surgery, though this exploratory risk stratification tool requires further validation.
Who should care
Limitations
This had a small sample size, 34 patients with only 5 technical failures, limiting statistical robustness; the authors explicitly state the cutoffs are hypothesis-generating and this is a demanding procedure requiring meticulous patient selection.
Combining two specific echocardiographic size ratios may help identify which patients with a challenging type of atrial septal defect anatomy are good candidates for catheter-based closure versus those who may need a different approach, though these criteria are still exploratory.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Transcatheter closure of secundum atrial septal defects (ASDs) with a deficient posteroinferior (PI) rim is challenging owing to an increased risk of technical failure.
Aims
This study aimed to explore morphological characteristics associated with a low-risk profile for procedural success in borderline candidates with PI rim deficiency.
Methods
In this retrospective study, we analyzed 34 patients with PI rim deficiency who underwent transcatheter closure attempts, excluding those initially triaged to surgery. Cut-off values for echocardiographic indices, including the defect-to-septal ratio (DSR) and the defect-to-left atrial volume ratio (DLAR), were determined using receiver operating characteristic (ROC) analysis. The diagnostic performance of single versus combined indices was evaluated.
Results
Procedural success was achieved in 29 patients (85%), and technical failure occurred in 5 (15%). Combining DSR and DLAR significantly improved risk stratification compared to DSR alone. Exploratory cut-offs for predicting technical failure were DSR ≥ 61.9% and DLAR ≥ 1.3 mm/mL. Fulfilling at least one low-risk criterion (DSR < 61.9% or DLAR < 1.3 mm/mL) effectively identified a highly favorable cohort, yielding a 100% (23/23) procedural success rate and improving overall diagnostic accuracy to 82%.
Conclusions
Assessing spatial mismatch between the defect and left atrium provides a practical framework for risk stratification in PI rim deficiency. While combined DSR and DLAR criteria identify a potential low-risk profile, these exploratory cut-offs remain hypothesis-generating. This demanding procedure requires extreme caution and meticulous patient selection.
DOI
10.1002/ccd.70873
PMID
42720718
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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