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The role of echocardiography in transcatheter closure of atrial septal defects

Published online by Cambridge University Press:  19 August 2008

Nynke J. Elzenga
Nynke J. Elzenga
Affiliation:
Division of pediatric Cardiology, University Hospital, Groningen, The Netberlands
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Abstract

Closure of so-called “secundum” atrial septal defects with a device inserted on a catheter necessitates precise delineation of their morphology. Echocardiography is the diagnostic method of choice to demonstrate this morphology, and to differentiate such defects located within the oval fossa from the other variants producing an interatrial communication. Precordial echocardiography usually allows selection of cases likely to be suitable for closure in this fashion. This selection is based on the localisation and the size of the deficiency in the oval fossa, the length of the interatrial septum, and the adequacy of the infolded rims surrounding the defect. Suitability for closure is reevaluated by transesophageal echocardiography, either asa separate investigation or at the start of the interventional theterisation. This investigation requires a multiplane transesophageal echocardiographic probe, since only oblique planes will demonstrate the entrance of the systemic and pulmonary veins and their relationship to the defect. Transesophageal echocardiography serves as an important monitoring tool during the interventional procedure. As such, it is a necessary adjunct to fluoroscopy. The stretched diameter of the defect measured with a balloon is the main eterminant of the choice of the type and size of the device. This diameter can be measured fluoroscopically, as well as on echo. Colorflow mapping serves to rule out residual shunting during the occlusion of the defect with the balloon. During deployment of the device, constant echocardiographic visualisation of the device and its position relative to the atrial septum facilitates proper placement. Such constant visualisation can only be provided by repeated quick acquisitions of multiple planes. Once the device is released, the investigator should continue to record the position of the device, and assess the potential for residual shunting.Most of the devices show some subtle change in position during the first 20 minutes after implantation.

Keywords

Ovel fossa defetctsInterventional Catherterisationcross-sectional echocardiographyballoon sizing
Type
Review Article
Information
Cardiology in the Young , Volume 10 , Issue 5 , September 2000 , pp. 474 - 483
Copyright
Copyright © Cambridge University Press 2000

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References

Hellenbrand, WE, Fahey, JT, McGowan, FX, Weltin, GG, Kleinman, CS. Transesophageal echocardiographic guidance of transcatheter closure of atrial septal defect. Am J Cardiol 66; 1990: 207–213.CrossRefGoogle ScholarPubMed
Rao, PS, Langhough, R, Beekman, RH, Lloyd, TR, Sideris, EB. Echocardiographic estimation of balloon–stretched diameter of secundum atrial septal defect for transcatheter occlusion. Am Heart J 124; 1992: 172–175.CrossRefGoogle ScholarPubMed
Godart, F, Rey, C, Francart, C, Jarrar, M, Vaksman, G. Two-dimen-sional echocardiographic and color Doppler measurements of atrial septal defect and comparison with the balloon-stretched diameter. Am J Cardiol 72; 1993: 1095–1097.CrossRefGoogle Scholar
Reddy, SCB, Rao, S, Ewenko, J, Koscik, R, Wilson, AD. Echocardiographic predictors of success of catheter closure of atrial septal defect with the buttoned device. Am Heart J 129; 1995: 76–82.CrossRefGoogle ScholarPubMed
Magni, GMagni, G, Hijazi, ZM, Pandian, NG, Dalabays, A, Sugeng, L, Laskari, C, Marx, GR. Two- and Three-dimensional transesophageal echocardiography in patient selection and assessment of atrial septal defect closure by the new DAS-Angel Wings device. Circulation 96; 1997: 1722–1728.CrossRefGoogle ScholarPubMed
Rosenfeld, HM, Vd Velde, ME, Sanders, SP, Colan, SD, Parness, IA, Lock, JE, Spevak, PJ. Echocardiographic predictors for successful transcatheter atrial septal defect closure. Cathet Cardiovasc Diag 34; 1995: 29–34.Google Scholar
Banerjee, A, Bengur, AR, Li, JS, Homans, DC, Toher, C, Bank, AJ, Merx, GR, Rhodes, J, Das, GS. Echocardiographic Characteristics of successful deployment of the Das Angel Wings atrial septal closure device: initial multicenter experience in the United States. Am J Cardiol 83; 1999: 1236–1241.Google Scholar
Kaulitz, R, Paul, T, Hausdorf, G. Extending the limits of transcatheter closure of atrial septal defects with the double umbrella device (CardioSeal). Heart 80; 1998: 54–59.CrossRefGoogle ScholarPubMed
Morimoto, K, Matsazaki, M, Tohma, Y, Ono, S, Tanaka, N, Michige, H, Murata, K, Anno, Y, Kusukawa, R. Diagnosis and quantitative evaluation of secundum-type atrial septal defect by transesophageal Doppler echocardiography. Am J Cardiol 66; 1990: 85–91.CrossRefGoogle ScholarPubMed
Schwinger, ME, Gindea, AJ, Freedberg, RS, Kronzon, I. The anatomy of the interatrial septum: a transesophageal echocardiographic study. Am Heart J 119; 1990: 1401–1405.CrossRefGoogle ScholarPubMed
Kronzon, I, Tunick, PA, Freedberg, RS, Trehan, N, Rosenzweig, BP, Schwinger, ME. Transesophageal echocardiography is superior to transthoracic echocardiography in the diagnosis of sinus venosus atrial septal defect. J Am Coll Cardiol 17; 1991: 537–542.Google Scholar
Boutin, C, Musewe, NN, Smallhorn, JF, Dyck, JD, Kobayashi, T, Benson, LN. Echocardiographic follow-up of atrial septal defect after catheter closure by doudle-umbrella device. Circulation 88; 1993: 621–627.CrossRefGoogle ScholarPubMed
Ishii, M, Kato, H, Inoue, O, Takagi, J, Maeno, Y, Sugimura, T, Miyake, T, Kumate, M, Kosuga, K, Ohishi, K. Biplane transesophagealecho–Doppler studies of atrial septal defects: quantitative evaluation and monitoring of transcatheter closure. Am Heart J 125; 1993: 1363–1368.CrossRefGoogle ScholarPubMed
Hijazi, ZM, Abu-Ata, I, Marx, GR. Clinical use of the 'das-angel wings- septal occluder device in children. Progr Ped Card 6; 1996: 169–176.CrossRefGoogle Scholar
Acar, PThree-dimensional Echocardiography in Transcatheter Closure of Atrial Septal Defects. Cardiol Young 2000; 10: 484–492.CrossRefGoogle ScholarPubMed
Hausdorf, G, Schneider, M, Franzbach, B, Kampman, C, Kargus, K, Goeldner, B. Transcatheter closure of secundum atrial septal defects with the atrial septal defect occlusion system (ASDOS): initial experiance in children. Heart 75; 1996: 83–88.Google ScholarPubMed