{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:29:01Z","timestamp":1790706541171,"version":"4.1.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>There is no standardized global framework for device size selection in transcatheter atrial septal defect (ASD) closure. We aimed to evaluate outcomes and insights from the routine application of a device selection strategy based on 3D transesophageal echocardiography (TEE) in consecutive patients undergoing ASD closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>The study population was derived from a prospective ASD_3D_Device_Size registry, in which device sizing was exclusively determined prior to the procedure by a 3D TEE-based formula. All patients were clinically followed for a median of 1.6 years after the procedure. Between September 2016 and May 2024, a total of 748 patients were included. Median procedural and fluoroscopy times were 18.0 and 3.7\u2005min, respectively. Procedure success rate was 99.5%. One patient (0.1%) required intraprocedural device size reselection. Device embolization occurred in three (0.4%) patients; two of these cases were attributed to delivery system malfunction. Device malposition was found in one (0.1%) patient, who underwent surgery. During follow-up, one patient required surgery for cardiac erosion. Among 186 (24.9%) oval ASDs, long axis orientations were diverse. Computational simulations demonstrated that, when balloon sizing was assumed to be performed in the fluoroscopic antero-posterior projection, the greatest underestimation of maximal diameter, with a discrepancy of 34.9%, occurred in the horizontally oriented oval ASDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pre-procedural determination of device size based on 3D TEE provides a safe and useful framework in routine clinical practice. Because of the diversity in maximal diameter orientation, balloon sizing using a fixed fluoroscopic angle may underestimate the true maximal diameter of an ASD.<\/jats:p>\n                    <jats:p>(ClinicalTrials.gov number NCT 02097758)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeag007","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T12:37:47Z","timestamp":1768048667000},"page":"905-912","source":"Crossref","is-referenced-by-count":1,"title":["Routine application of three-dimensional transesophageal echocardiography-based device selection for transcatheter closure of atrial septal defect without balloon sizing"],"prefix":"10.1093","volume":"27","author":[{"given":"Pil Hyung","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ga Yun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Sung","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inbae","family":"Earm","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung Beom","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Artificial Intelligence, Ajou University , Suwon ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Il","family":"Koo","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, Ajou University , Suwon ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae Oh","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahmin","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung Joo","family":"Sun","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae-Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 ,","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duk-Hyun","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505 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