Short-term outcomes of transcatheter atrial septal defect closure without balloon sizing at Hanoi Heart Hospital

Abstract

Background: Balloon sizing is a conventional method used to determine an appropriate device size for percutaneous closure of atrial septal defects (ASDs). However, balloon sizing has certain limitations, including potential overestimation of the actual defect size, increased treatment costs, and prolonged procedure time. Objective: To evaluate the short-term outcomes of percutaneous ASD closure without balloon sizing at Hanoi Heart Hospital. Methods: From October 2025 to June 2026, 104 patients with ASD underwent percutaneous device closure without balloon sizing at Hanoi Heart Hospital. Clinical, echocardiographic, procedural, and post-procedural follow-up data were collected and analyzed. The mean follow-up duration was 5.6 months, ranging from 3 to 10 months. Results: Procedural success was achieved in all 104 patients (100%), defined as successful deployment of the device in the appropriate position, stable device fixation on testing, and absence of compression or obstruction of adjacent anatomical structures. In 98 patients (94.2%), the device was successfully deployed using the initially selected size according to the sizing formula. The remaining 6 patients (5.8%) required adjustment of device size or balloon-assisted deployment: 2 required a larger device, 2 required a smaller device, and 2 required balloon assistance. All 6 cases were successfully completed. No vascular complications, device embolization, or pericardial effusion were observed during follow-up. Three patients (2.9%) developed arrhythmias: 2 had sinus bradycardia and 1 developed transient third-degree atrioventricular block one week after the procedure. All arrhythmias resolved completely without the need for permanent pacemaker implantation. Conclusion: Percutaneous ASD closure without balloon sizing is a safe and effective treatment option for patients with suitable anatomical characteristics, with a high procedural success rate and short procedure and fluoroscopy times. This approach may reduce the use of additional consumable materials during the procedure. However, further studies with larger sample sizes and longer follow-up are needed to evaluate mid- and long-term outcomes and to identify factors associated with technical failure.