Background. To evaluate the feasibility of using a single device to close multiple atrial septal defects (ASDs) under the guidance of transthoracic echocardiography (TTE) and with the aid of three-dimensional (3D) printing models. Methods. Sixty-two patients with multiple ASDs were retrospectively analyzed. Thirty of these patients underwent TTE-guided closure (3D printing and TTE group) after a simulation of occlusion in 3D printing models. The remaining 32 patients underwent ASD closure under fluoroscopic guidance (conventional group). Closure status was assessed immediately and at 6 months after device closure. Results. Successful transcatheter closure with a single device was achieved in 26 patients in the 3D printing and TTE group and 27 patients in the conventional group. Gender, age [18.8 ± 15.9 (3–51) years in the 3D printing and TTE group; 14.0 ± 11.6 (3–50) years in the conventional group], mean maximum distance between defects, prevalence of 3 atrial defects and large defect distance (defined as distance ≥7 mm), and occluder size used were similarly distributed between groups. However, the 3D printing and TTE group had lower frequency of occluder replacement (3.8% vs 59.3%, p<0.0001), prevalence of mild residual shunts (defined as <5 mm) immediately (19.2% vs 44.4%, p<0.05) and at 6 months (7.7% vs 29.6%, p<0.05) after the procedure, and cost (32960.8 ± 2018.7 CNY vs 41019.9 ± 13758.2 CNY, p<0.01). Conclusion. The combination of the 3D printing technology and ultrasound-guided interventional procedure provides a reliable new therapeutic approach for multiple ASDs, especially for challenging cases with large defect distance.

The percutaneous and non-fluoroscopic (PAN) technique represents a major breakthrough in cardiovascular intervention, offering innovative solutions to address the limitations of traditional fluoroscopically guided procedures, including radiation exposure, contrast agent-related risks and burdensome requirements for lead aprons. This review examines the fundamental principles, implementation methodologies and indications for PAN technique. Through integration of advanced imaging guidance systems and transcatheter techniques, the PAN technique achieves radiation-free or low-radiation intervention procedures for various structural heart conditions. Based on current research evidence, the PAN technique not only significantly reduces iatrogenic injury risks but also delivers clinical outcomes comparable or superior to conventional methods. By eliminating radiation exposure and improving accessibility, the PAN technique establishes a safe, effective and economically viable pathway for minimally invasive cardiovascular interventions, with potential for broader application in future cardiovascular intervention practice.

Structural heart disease affects patients across all age groups and traditionally requires invasive open-heart surgery or percutaneous interventions with radiation exposure. Percutaneous and non-fluoroscopic (PAN) procedures enable non-thoracotomy, radiation-free treatment using echocardiographic guidance for structural heart interventions. This article examines the application of PAN procedures in atrial septal defect (ASD) closure, patent foramen ovale closure and transcatheter edge-to-edge repair (TEER). The most robust evidence for the use of the PAN procedure is in ASD closure, with Chinese studies reporting procedural success rates improving from 92–96.5% in early studies to 98–100% in recent studies. International validation from German, Iranian and Indonesian centres and a meta-analysis of eight studies confirm consistent success rates of 94–100% across diverse healthcare settings. The PAN procedure in the patent foramen ovale closure shows promising feasibility, with success rates of 95–100% and manageable learning curves requiring approximately 50 cases for proficiency. The PAN procedure has reportedly achieved high procedural success for TEER in small samples, although its use for TEER requires further validation. As a radiation-free approach, the PAN procedure offers significant advantages, including eliminating radiation exposure, enhanced accessibility in resource-limited settings and potential cost reductions.