Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T09:21:03.488Z Has data issue: false hasContentIssue false
  • English
  • Français

Transesophageal echocardiographic predictors for successful transcatheter closure of defects within the oval fossa using the CardioSEAL® septal occlusion device

Published online by Cambridge University Press:  19 August 2008

Tarek S. Momenah ,
Doff B. McElhinney ,
Michael M. Brook ,
Phillip Moore  and
Norman H. silverman
Tarek S. Momenah
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Doff B. McElhinney
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Michael M. Brook
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Phillip Moore
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Norman H. silverman
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To define the utility of transesophageal echocardiography in predicting the likelihood of a successful procedure and residual shunting in patients undergoing transcatheter closure of defects within the oval fossa using the CardioSEAL® device.

Background

Transesophageal echocardiography is used to monitor transcatheter closure of interatrial defects within the the oval fossa, but predictors of successful closure and residual shunting have yet to be determined.

Methods

We reviewed transesophageal echocardiograms obtained from 26 consecutive patients undergoing attempted transcatheter closure of interatrial defects within the oval fossa between January, 1997 and May, 1998. Assessment of the atrial septum, the septal defect, and the rims of the oval fossa bordering the defect was performed in 3 planes: longitudinal, 4- chamber, and basal short-axis.

Results

Closure proved successful in 24 patients (92%). The defect was significantly larger, and the anterosuperior rim of the defect smaller, in the 2 patients in whom occlusion was not successful. Residual shunting 24 hrs after closure was detected in 14 patients. Significant predictors of leakage included smaller posterior and superior rims, a larger shunt prior to closure, and herniation of a one left atrial arm of the device into the right atrium. In all cases, the sites of leakage were the superior rim of the defect at the superior cavo-atrial junction, and the anterosuperior rim behind the aortic root. Herniation of a left atrial arm into the right atrium was seen in 7 patients (29%). In all, it was the anterosuperior arm which herniated Doppler color flow was suboptimal in detecting residual leaks, and was enhanced substantially with the use of contrast echocardiography.

Conclusions

Transesophageal echocardiography allows excellent assessment of the oval fossa and deficiencies of its floor in all of their dimensions. It is an important tool for guiding the deployment of the occlusion device in patients undergoing attempted transcatheter closure of defects within the fossa. Contrast echocardiography should be used for optimal detection of residual shunting.

Keywords

Atrial septal defectinterventional closuresecundum defects
Type
original-article
Information
Cardiology in the Young , Volume 10 , Issue 5 , September 2000 , pp. 510 - 518
Copyright
Copyright © Cambridge University Press 2000

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, Steiner, C, Mills, NL. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. Jama 1976; 235: 2506–2509.Google ScholarPubMed
2.King, TD, Mills, NL. Nonoperative closure of atrial septal defects. Surgery. 1974; 75: 383–388.Google ScholarPubMed
3.Sievert, H, Babic, UU, Ensslen, R, Scherer, D, Spies, H, Wiederspahn, T, Zeplin, HE. Transcatheter closure of large atrial septal defects with the Babic system [see comments]. Catheterization and Cardiovascular Diagnosis. 1995; 36: 232–240.CrossRefGoogle ScholarPubMed
4.Sievert, H, Babic, UU, Hausdorf, G, Schneider, M, HL”pp, HW, Pfeiffer, D, Pfisterer, M, Friedli, B, Urban, P. Transcatheter closure of atrial septal defect and patent foramen ovale with ASDOS device (a mulci-institutional European trial). American Journal of Cardiology 1998; 82: 1405–1413.CrossRefGoogle ScholarPubMed
5.Rao, PS, Sideris, EB, Hausdorf, G, Rey, C, Lloyd, TR, Beekman, RH, Worms, AM, Bourlon, F, Onorato, E, Khalilullah, M, et, al. International experience with secundum atrial septal defect occlusion by the buttoned device. American Heart Journal. 1994; 128: 1022–1035.CrossRefGoogle ScholarPubMed
6.Prieto, LR,Foreman, CK,Cheatham, JP,Latson, LA. Intermediate-term outcome of transcatheter secundum atrial septal defect closure using the Bard Clamshell Septal Umbrella. American Journal of Cardiology. 1996; 78: 1310–1312.CrossRefGoogle ScholarPubMed
7.Masura, J,Gavora, P,Formanek, A,Hijazi, ZM. Transcatheter closure of secundum atrial septal defects using the new selfcentering amplatzer septal occluder: initial human experience[see comments]. Catheterization and Cardiovascular Diagnosis. 1997; 42: 388–393.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
8.Kaulitz, R, Paul, T, Hausdorf, G. Extending the limits of transcatheter closure of atrial septal defects with the double umbrella device (CardioSEAL). Heart. 1998; 80: 54–59.CrossRefGoogle ScholarPubMed
9.Hausdorf, G, Schneider, M, Fink, C, Neudorf, U, Fischer, G, Tynan, M, Friedli, B. Transcatheter closure of atrial septal defects with in the oval fossa: medium-term results in children using the ‘ASDOS’-technique. Cardiology in the Young 1998; 8: 462–71.CrossRefGoogle ScholarPubMed
10.Landzberg, MJ,Sloss, LJ,Faherty, CE,Morrison, BJ,Bittl, JA, Bridges, ND, Casale, PN, Keane, JF, Lock, JE. Orthodeoxiaplatypnea due to intracardiac shunting-relief with transcatheter double umbrella closure. Catheterization and Cardiovascular Diagnosis 1995; 36: 247–250.CrossRefGoogle ScholarPubMed
11.Rome, JJ, Keane, JF, Perry, SB, Spevak, PJ, Lock, JE. Doubleumbrella closure of atrial defects. Initial clinical applications. Circulation 1990; 82: 751–758.Google ScholarPubMed
12.VanHare, GF, Silverman, NH. Contrast two-dimensional echocardiography in congenital heart disease: techniques, indications and clinical utility. J Am Coll Cardiol. 1989; 13: 673–686.CrossRefGoogle Scholar
13.Belohlavek, M, Foley, DA, Gerber, TC, Greenleaf, JF, Seward, JB. Three-dimensional ultrasound imaging of the atrial septum: normal and pathologic anatomy. Journal of the American College of Cardiology. 1993; 22: 1673–1678.CrossRefGoogle ScholarPubMed
14.Magni, G, Hijazi, ZM, Pandian, NG, 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 DASAngel Wings device: initial clinical experience.Circulation. 1997; 96: 1722–1728.CrossRefGoogle ScholarPubMed
15.Lock, JE, Cockerham, JT, Keane, JF, Finley, JP, Wakely, PE, Fellows, KE Jr. Transcatheter umbrella closure of congenital heart defects. Circulation 1987; 75: 593–599.CrossRefGoogle ScholarPubMed
16.Rosenfeld, HM, vanderVelde, ME, Sanders, SP, Colan, SD, Parness, IA, Lock, JE, Spevak, PJ. Echocardiographic predictors of candidacy for successful transcatheter atrial septal defect closure. Catheterization and Cardiovascular Diagnosis 1995; 34: 29–34.CrossRefGoogle ScholarPubMed
17.Banerjee, A, Bengur, AR, Li, JS, Homans, DC, Toher, C,Bank, AJ,Marx, GR,Rhodes, J,Das, GS. Echocardiographic characteristics of successful deployment of the Das AngelWings atrial septal defect closure device: initial multicenter experience in the United States. American Journal of Cardiology 1999; 83: 1236–1241.CrossRefGoogle ScholarPubMed
18.Reddy, SC, Rao, PS, Ewenko, J, Koscik, R, Wilson, AD. Echocardiographic predictors of success of catheter closure of atrial septal defect with the buttoned device. American Heart Journal 1995; 129: 76–82.CrossRefGoogle ScholarPubMed
19.Justo, RN, Nykanen, DG, Boutin, C, McCrindle, BW, Freedom, RM, Benson, LN. Clinical impact of transcatheter closure of secundum atrial septal defects with the double umbrella device. American Journal of Cardiology 1996; 77: 889–892.CrossRefGoogle ScholarPubMed
20.Boutin, C, Musewe, NN, Smallhorn, JF, DyckJD,, Kobayashi T, Benson, LN. Echocardiographic follow-up of atrial septal defect after catheter closure by double-umbrella device. Circulation 1993; 88: 621–627.CrossRefGoogle ScholarPubMed
21.Ishii, M, Kato, H, Inoue, O, Takagi, J, Maeno, Y, Sugimura, T, Miyake, T, Kumate, M, Kosuga, K, Ohishi, K. Biplane transesophageal echo-Doppler studies of atrial septal defects: quantitative evaluation and monitoring for transcatheter closure. American Heart Journal 1993; 125: 1363–1368.CrossRefGoogle ScholarPubMed
22.Morimoto, K, Matsuzaki, M, Tohma, Y, Ono, S, Tanaka, N, Michishige, H, Murata, K, Anno, Y, Kusukawa, R. Diagnosis and quantitative evaluation of secundum-type atrial septal defect by transesophageal Doppler echocardiography. American Journal of Cardiology 1990; 66: 85–91.CrossRefGoogle ScholarPubMed
23.Ewert, P, Daehnert, I, Berger, F, Kaestner, A, Krings, G, Vogel, M, Lange, PE. Transcatheter closure of atrial septal defects under echocardiographic guidance without X-ray: initial experiences. Cardiology in the Young 1999; 9: 136–140.CrossRefGoogle ScholarPubMed