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Transcatheter closure of atrial septal defects under echocardiographic guidance without X-ray: initial experiences

Published online by Cambridge University Press:  19 August 2008

Peter Ewert ,
Ingo Daehnert ,
Felix Berger ,
Andreas Kaestner ,
Gregor Krings ,
Michael Vogel  and
Peter E. Lange
Peter Ewert*
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Ingo Daehnert
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Felix Berger
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Andreas Kaestner
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Gregor Krings
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Michael Vogel
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Peter E. Lange
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
*
Peter Ewert, MD, Dept. of Pediatric Cardiology, German Heart Institute, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: ++ 49/30-4593-2800; Fax: ++ 49/30-4593-2900; email:ewert@dhab.de
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Abstract

Background

Transcatheter closure of atrial septal defects is performed under fluoroscopy, but echocardiography has gained an important role in the procedure. With the new Amplatzer Septal Occluder a device has become available which is easy to implant with minimal fluoroscopy time. We developed an interventional procedure with this device under transesophageal echocardiography alone without fluoroscopy.

Methods and Results

Four patients (3 to 16 years of age, bodyweight 14 to 60 kg) with atrial septal defects centrally located in the oval fossa were elected for transcatheter closure. After sedation with midazolam and propofol a diagnostic and interventional catheterization was performed in all cases without fluoroscopy. Oxymetric shunt was Qp: Qs = 1.7 (1.5 to 2.1). Under transesophageal echocardiography, the defects were sized over the wire with a balloon catheter. Mean balloon stretched diameter was 10 mm (7 to 14 mm). Under transesophageal echocardiography an Amplatzer Septal Occluder was placed into the defect. In two patients this was achieved with a 5 MHz monoplane pediatric transducer, in two patients a 10mm 5 MHz multiplane probe was used. Complete closure was achieved in all patients and no complications were encountered.

Conclusion

We conclude that in selected cases with an atrial septal defect located in the oval fossa and clear-cut echocardiographic findings, an Amplatzer Septal Occluder can be safely deployed under echocardiographic guidance alone.

Keywords

atrial septal defectinterventional cardiologytransesophageal echocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 2 , March 1999 , pp. 136 - 140
Copyright
Copyright © Cambridge University Press 1999

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