Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-25T14:31:07.306Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of dynamic 3D transoesoesophageal echoardiography in the assessment of atrial septal defects and occlusion by the double-umbrealla device(CardioSEAL)

Published online by Cambridge University Press:  19 August 2008

Yasuki V. Maeno ,
Lee N. Benson  and
Christine Boutin
Yasuki V. Maeno
Affiliation:
Division of Cardiology and Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, Toronto, Ontario, canadaUniversity of Toronto School of Medicine, Toronto, Ontario, Canada
Lee N. Benson
Affiliation:
Division of Cardiology and Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, Toronto, Ontario, canadaUniversity of Toronto School of Medicine, Toronto, Ontario, Canada
Christine Boutin*
Affiliation:
Division of Cardiology and Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick Children, Toronto, Ontario, canadaUniversity of Toronto School of Medicine, Toronto, Ontario, Canada
*
Dr Christine Boutin, Division of Cardiology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Tel: 416 813 6674, Fax: 416 813 7547
Get access Rights & Permissions [Opens in a new window]

Abstract

Occlusion of the atrial septal defects in the oval fossa by interventional catheterization has progressed, but still has limitations. Three-dimensional (3D) echocardiography can provide unique views unavailable by cross-sectional imaging. The objective of this study was to define the clinical application of 3D echocardiography in the assessment and monitoring of transcatheter occlusion of atrial septal defects. Three-dimensional echocardiography was attempted prior to occlusion of atrial septal defects in 41 patients (median age 8.6 years). Serial cross-sectional images were acquired by multiplane transoesophageal echocardiography and displayed by means of computer reconstruction. Dynamic 3D echocardiographic images of defects in the oval fossa were obtained in 40 of 41 patients (98%). Volume-rendering demonstrated the anterosuperior rim in 36 (90%) and the inferoposterior rim in 24 (60%), but failed to reveal small additional fenestrations in six. Sizes measured by 3D echocardiography were significantly larger than those provided by cross-sectional transoesophageal echocardiography (p =;0.007), but differed little from those obtained with balloon sizing (p =; 0.6). After occlusion, 3D echocardiography showed positions of all arms of the device in 20 of 24 cases. Location of any protruding arms, or residual defects, were also clearly revealed.Three-dimensional images obtained in 12 patients during deployment of the double-umbrella device were useful in monitoring its position (single-frame) and for explaining the mechanism of protrusion. Current 3D echocardiography provides clinically relevant information for selection of patients for closure of atrial septal defects by interventional catheterization and when monitoring during implantation. Information obtained by this technique can clarify the mechanism of deployment of the device and closure of the defect, therefore influencing outcomes.

Keywords

Echocardiography3Dheart septal defectsatrialheart catheterizationinterventional closure
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 3 , July 1998 , pp. 368 - 378
Copyright
Copyright © Cambridge University Press 1998

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

1.King, TD, Thompson, SL, Mills, NL. Measurement of atrial septal defect during cardiac catheterization. Am J Cardiol. 1978; 41: 537–542.Google Scholar
2.Rashkind, WJ. Transcatheter treatment of congenital heart disease. Circulation. 1983; 67: 711–716.CrossRefGoogle ScholarPubMed
3.Rome, JJ, Keane, JF, Perry, SB, Spevak, PJ, Lock, JE. Double umbrella closure of atrial defects: initial clinical applications. Circulation 1990; 82: 751–758.CrossRefGoogle ScholarPubMed
4.Sideris, EB, Sideris, SE, Thanopoulos, BD, Ehly, RL, Fowlkes, JP. Transvenous atrial septal defect occlusion by the buttoned device. Am J Cardiol. 1990; 66: 1524–1526.CrossRefGoogle ScholarPubMed
5.Das, GS, voss, G, Jarvis, G, Wyche, K, Gunther, R, Wilson, RF. Experimental atrial septal defect closure with a new, transcatheter, self-centering device. Circulation 1993; 88: 1754–1764.Google Scholar
6.Hausdorf, G, Schneider, M, Franzbach, B, Kampmann, C, Kargus, K, Goeldner, B. Transcatheter closure of secundum atrial septal defects with the atrial septal defect occlusion system (ASDOS): initial experience in children. Heart. 1996; 75: 83–88.CrossRefGoogle ScholarPubMed
7.Sharafuddin, MJA, Gu, X, Titus, JL, Urness, M, Cervera-Ceballos, JJ, Amplatz, K. Transvenous closure of secundum atrial septal defects. Preliminary results with a new self-expanding Nitinolprosthesis in a swine model. Circulation 1997; 95: 2162–2168.CrossRefGoogle Scholar
8.Boutin, C, Musewe, NN, Smallhorn, JF, Dyck, JD, Kobayashi, T, Benson, L. Echocardiographic follow-up of atrial septal defect after catheter closure by double-umbrella device. Circulation 1993; 88: 621–627.Google Scholar
9.Agarwal, SK, Ghosh, PK, Mittal, PK. Failure of devices used for closure of attrial septal defects: mechanisms and management. J Thorac Cardiovasc Surg 1996; 112: 21–26.Google Scholar
10.Ishii, M, Kato, H, Inoue, O, Takagi, J, Maeno, Y, Sugimura, T, Miyake, T, Kumate, M, Kosuga, K, Ohishi, K. Biplane transoesophageal echo-Doppler studies of atrial septal defects: quantitative evaluation and monitoring for transcatheter closure. Am Heart J 1993; 125: 1363–1368.Google Scholar
11.Lloyd, TR, Vermilion, RP, Zamora, R, Ludomirsky, A, Beekman, RH. Influence of echocardiographic guidance on positioning ofthe buttoned occluder for transcatheter closure of atrial septaldefects. Echocardiography 1996; 13: 117–121.CrossRefGoogle Scholar
12.Belohlavek, M, Foley, DA, Gerber, TC, Greenleaf, JF, seward, JB. Three-dimensional ultrasound ultrasound imaging of the attrial septum: normal and pathologic anatomy. J Am Coll Cardiol 1993; 22: 1672–1678.CrossRefGoogle ScholarPubMed
13.Magni, G, Cao, Q-L, Sugeng, L, Delabays, A, Marx, G, Ludomirski, A, Vogel, M, Pandian, NG. Volume-rendered, three-dimensional echocardiographic determination of the size, shape and position of atrial septal defects: validation in an in vitro model. Am Heart J 1996; 132: 376–381.CrossRefGoogle ScholarPubMed
14.Vogel, MLösch, S, Bühlmeyer, K. The application of transthoracic dynamic three-dimensional echocardiography by computer-controlled parallel slicing in patients with fixed subaortic obstruction. Cardiol Young 1994; 4: 7–14.CrossRefGoogle Scholar
15.Marx, GR, Fulton, DR, Pandian, NG, Vogel, M, Cao, Q-L, Ludomistrisky, A, Delabays, A, Sugeng, L, Kals, D. Delineation of site, relative size and dynamic geometry of attrial septal defects by real-time three-dimensional echocardiology. J Am Coll Cardiol 1995; 25: 482–490.Google Scholar
16.Magni, G, Hijazi, ZM, Pandian, MG, Delabays, 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 1997; 96: 1722–1728.Google Scholar
17.Franke, A, Kühl, HP, Rulands, D, Jansen, C, Erena, C, Grabitz, RG, Däbritz, S, Messmer, BJ, Flachskampf, FA, Hanrath, P. Quantitative analysis of the morphology of secundum-type atrial septal defect and their dynamic change using transesophageal three-dimensional echocardiography. Circulation 1997;96 II: 323–327.Google ScholarPubMed
18.Cheng, TO, Xie, M-X, Wang, X-F, Li, Z-A, Hu, G. Evaluation of mitral valve prolapse by four-dimensional echocardiography. Am Heart J. 1997; 133: 120–129.CrossRefGoogle ScholarPubMed
19.Seward, JB, Khandheria, BK, Oh, JK, Abel, MD, Hughes, RW, Edwards, WD, Nichols, BA, Freeman, WK, Tajik, AJ. Transesophageal echocardiography: technique, anatomic correlations, implementation and clinical applications. Mayo Clin Proc 1988; 63: 649–680.Google Scholar
20.Ferreira, SMAG, 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; 316: 316–320.Google Scholar
21.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.CrossRefGoogle ScholarPubMed