However, transthoracic echocardiography (TTE) can only be implemented intermittently during fluoroscopy.  We developed a custom-made TTE monitoring apparatus using artificial hand (AH-TTE) that enables real-time TTE images during atrial septal defect (ASD) closure.  Thirty-two patients underwent successful device implantation using AH-TTE monitoring without complications.  The median duration for real-time AH-TTE monitoring was 22 min and the median fluoroscopy time was 7.2 min.  Our simple and novel monitoring technique with AH-TTE provides TEE-like monitoring and may be a new alternative method for ASD closure.  It gives real-time stable TTE images and minimizes radiation exposure for the interventional team during fluoroscopy.
TTE
We developed a custom-made TTE monitoring apparatus using artificial hand (AH-TTE) that enables real-time TTE images during atrial septal defect (ASD) closure.  Thirty-two patients underwent successful device implantation using AH-TTE monitoring without complications.  The median duration for real-time AH-TTE monitoring was 22 min and the median fluoroscopy time was 7.2 min.  Our simple and novel monitoring technique with AH-TTE provides TEE-like monitoring and may be a new alternative method for ASD closure. 
AH-TTE
We developed a custom-made TTE monitoring apparatus using artificial hand (AH-TTE) that enables real-time TTE images during atrial septal defect (ASD) closure.  Thirty-two patients underwent successful device implantation using AH-TTE monitoring without complications.  The median duration for real-time AH-TTE monitoring was 22 min and the median fluoroscopy time was 7.2 min.  Our simple and novel monitoring technique with AH-TTE provides TEE-like monitoring and may be a new alternative method for ASD closure. 
AH-TTE