Objective To explore the application value of the trans-esophageal echocardiography (TEE) for the trans-thoracic minimal invasive occlusion
surgery of infantile multiple atrial septal defect (ASD). Methods The right atrium of 18 patients with multiple ASD was exposed by minimal invasive incision
besides the right sternum. The size and number of ASD and the distance between ASD were measured by the guidance of TEE. According to the measurements,
proper ASD occluders were selected. The sleeve of occluder went through atrial septal defect, entered the left atrium, and occluded the multiple ASD by the
guidance of TEE. The results of treating the multiple ASD by the occluder were evaluated immediately after the operation. Results Multiple ASD of 18 patients
were all occluded by one occluder for each patient. Immediate TEE examination after operation showed that all occluders were in good positions without
deformations, movements, and shedding. Multiple ASD had no residual shunt. Functions of cardiac valves were not affected. Conclusion The treatment of infantile
multiple ASD by the trans-thoracic minimal invasive occlusion surgery is a safe and effective technology. TEE is clinically very important for selecting
cases and occluders, intra-operative guidance and observations, and follow-up.