Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T02:15:00.913Z Has data issue: false hasContentIssue false
  • English
  • Français

Echocardiographic considerations during deployment of the Helex Septal Occluder for closure of atrial septal defects

Published online by Cambridge University Press:  24 May 2005

Leo Lopez ,
Roque Ventura ,
Elizabeth M. Welch ,
David G. Nykanen  and
Evan M. Zahn
Leo Lopez
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
Roque Ventura
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
Elizabeth M. Welch
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
David G. Nykanen
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
Evan M. Zahn
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

The Helex Septal Occluder is a new device used to close atrial septal defects via interventional catheterization. In order to study the role of echocardiography during its use, and to describe the morphologic variants of defects suitable for closure with this occluder, we evaluated all patients undergoing intended closure of an atrial septal defect with the Helex occluder. A combination of transthoracic, transesophageal, three-dimensional, and intracardiac echocardiography were used before, during, and after the procedure to characterize anatomy, assess candidacy for closure, guide the device during its deployment, and evaluate results. Among the 60 candidates included in the study, 11 were excluded because of transesophageal echocardiographic and/or catheterization data obtained in the laboratory. Attempts at closure were successful in 46 patients, and unsuccessful in 3. We successfully treated four types of defects. These were defects positioned centrally within the oval fossa with appreciable rims along the entire circumference of the defect, defects with deficient or absent segments of the rim, defects with aneurysm of the primary atrial septum, and defects with multiple fenestrations. Follow-up transthoracic echocardiograms taken at a median of 7 months demonstrated no residual defects in 21, trivial residual defects in 17, and small residual defects in 8 patients. In 20 patients, three-dimensional reconstructions were used to characterize the morphology of the defect and the position of the device. Because transesophageal echocardiography was often limited by acoustic interference from the device, intracardiac echocardiography was utilized in 3 cases to overcome this limitation.

Keywords

Oval fossa defectinterventional catheterizationtransesophageal echocardiographythree-dimensional reconstructionintracardiac echocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 3 , June 2003 , pp. 290 - 298
Copyright
© 2003 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

King TD, Thompson SL, Steiner C, Mills NL. Secundum atrial septal defect: non-operative closure during cardiac catheterization. JAMA 1976; 235: 2506–2509.Google Scholar
Rome JJ, Keane JF, Perry SB, Spevak PJ, Lock JE. Double-umbrella closure of atrial septal defects: initial clinical applications. Circulation 1990; 82: 751–758.Google Scholar
Lloyd TR, Rao PS, Beekman RH 3rd, Mendelsohn AM, Sideris EB. Atrial septal defect occlusion with a buttoned device (a multi-institutional U.S. trial). Am J Cardiol 1994; 73: 286–291.Google Scholar
Hausdorf G, Schneider M, Fink C, et al. Transcatheter closure of atrial septal defects within the oval fossa: medium-term results in children using the “ASDOS” technique. Cardiol Young 1998; 8: 462–471.Google Scholar
Masura J, Gavora P, Formanek A, Hijazi ZM. Transcatheter closure of secundum atrial septal defects using the new self-centering Amplatzer septal occluder: initial human experience. Cathet Cardiovasc Diagn 1997; 42: 388–393.Google Scholar
Zahn EM, Wilson N, Cutright W, Latson LA. Development and testing of the Helex septal occluder, a new expanded polytetra-fluoroethylene atrial septal defect occlusion system. Circulation 2001; 104: 711–716.Google Scholar
Latson LA, Zahn EM, Wilson N. Helex septal occluder for closure of atrial septal defects. Curr Interv Cardiol Rep 2000; 2: 268–273.Google Scholar
Seward JB, Khandheira BK, Oh JK, et al. Transesophageal echocardiography: technique, anatomic correlations, implementations, and clinical applications. Mayo Clin Proc 1988; 63: 649–680.Google Scholar
Rosenfeld HM, van der Velde ME, Sanders SP, et al. Echocardiographic predictors of candidacy for successful transcatheter atrial septal defect closure. Cath Cardiovasc Diag 1995; 34: 29–34.Google Scholar
Cooke JC, Gelman JS, Harper RV. Echocardiologists' role in the deployment of the Amplatzer atrial septal occluder device in adults. J Am Soc Echocardiogr 2001; 14: 588–594.Google Scholar
Sweeney LJ, Rosenquist GC. The normal anatomy of the atrial septum in the human heart. Am Heart J 1979; 98: 194–199.Google Scholar
Ferreira SM, Ho SY, Anderson RH. Morphological study of defects of the atrial septum within the oval fossa: implications for transcatheter closure of left-to-right shunt. Br Heart J 1992; 67: 316–320.Google Scholar
Podnar T, Martanovic P, Gavora P, Masura J. Morphological variations of secundum-type atrial septal defects: feasibility for percutaneous closure using Amplatzer septal occluders. Cathet Cardiovasc Intervent 2001; 53: 386–391.Google Scholar
Chan KC, Godman MJ. Morphological variations of fossa ovalis atrial septal defects (secundum): feasibility for transcutaneous closure with the clam-shell device. Br Heart J 1993; 69: 52–55.Google Scholar
Hijazi Z, Wang Z, Cao Q, Koenig P, Waight D, Lang R. Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography. Cathet Cardiovasc Intervent 2001; 52: 194–199.Google Scholar
Maeno YV, Benson LN, Boutin C. Impact of dynamic 3D transoesophageal echocardiography in the assessment of atrial septal defects and occlusion by the double-umbrella device (CardioSEAL). Cardiol Young 1998; 8: 368–378.Google Scholar
Boutin C, Musewe NN, Smallhorn JF, et al. Echocardiographic follow-up of atrial septal defect after catheter closure by double-umbrella device. Circulation 1993; 88: 621–627.Google Scholar
Cao QL, Radtke W, Berger F, Zhu W, Hijazi ZM. Transcatheter closure of multiple atrial septal defects: initial results and value of two- and three-dimensional transesophageal echocardiography. Eur Heart J 2000; 21: 941–947.Google Scholar