Safety and feasibility of transesophageal echocardiography in comparison to transthoracic echocardiography-guided ventricular septal defect percutaneous closure: An evidence-based case report

Background: Perimembranous ventricular septal defect remained as the most prevalent congenital cardiac malform-ation. Due to the conjunction of transcatheter delivery technique with fluoroscopic imaging which posed greater radiation stochastic effect to both the operators and the patients, an echocardiographic-guided percutaneous closure method was recently established. Thus, comparative analysis between transesophageal and transthoracic echocardio-graphy to aid percutaneous closure of ventricular septal defect was proposed to assess their safety and feasibility profiles. Method: Advance searching was conducted via Boolean operators from eight databases. Two out of 927 studies were systematically selected as finally reviewed articles. The articles were then appraised using the Center for Evidence-Based Medicine Qualitative Studies Appraisal Tool prior to result analyses. Results: Two studies exhibit overall low risk bias results and had successfully described the qualitative approaches as these criteria embodied important aspects of the discuss-ion in justifying the concluding statements. Transcatheter closure of perimembranous ventricular septal defect using transthoracic echocardiography has reduced procedural time with its relatively convenient usage than that of transesophageal echocardiography. Despite its feasibility, transthoracic echocardiography provides a narrower mobil-ity of view to adjust device placement than that of trans-esophageal echocardiography. Nevertheless, transesoph-ageal echo-guided closure poses higher risks of injuries in infants, such as gastrointestinal and respiratory compr-ession. Conclusion: Echocardiography has become a preferred imaging modality compared to fluoroscopy in guiding transcatheter ventricular septal defect closure. Considering its numerous findings in adult patients, transesophageal echocardiography executes better guidance for the procedure than that of transthoracic echocardiography due to its clear and deeply penetrated images with faster procedural time.