Prospective Randomized Trial of Transthoracic Echocardiography Versus Transesophageal Echocardiography for Assessment and Guidance of Transcatheter Closure of Atrial Septal Defects in Children Using the Amplatzer Septal Occluder

AbstractBackgroundTranscatheter 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 ResultsFour 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.ConclusionWe 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.

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The role of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects by the Amplatzer septal occluder

American Heart Journal ◽

10.1067/mhj.2001.116770 ◽

2001 ◽

Vol 142 (3) ◽

pp. 482-488 ◽

Cited By ~ 67

Author(s):

Uros Mazic ◽

Pavol Gavora ◽

Jozef Masura

Keyword(s):

Transesophageal Echocardiography ◽

Transcatheter Closure ◽

Amplatzer Septal Occluder ◽

Septal Defects ◽

Atrial Septal Defects

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The value of transesophageal echocardiography in transcatheter closure of atrial septal defects in the oval fossa using the Amplatzer septal occluder

Cardiology in the Young ◽

10.1017/s1047951101000117 ◽

2001 ◽

Vol 11 (2) ◽

pp. 201-204 ◽

Cited By ~ 11

Author(s):

Haifa A. Latiff ◽

Hasri Samion ◽

Geetha Kandhavel ◽

Bilkis A. Aziz ◽

Mazeni Alwi

Keyword(s):

Transesophageal Echocardiography ◽

Transcatheter Closure ◽

Pulmonary Veins ◽

Sinus Venosus ◽

Amplatzer Septal Occluder ◽

Extra Information ◽

Septal Defects ◽

Multiple Defects ◽

Atrial Septal Defects ◽

The Right

Background: From January, 1997, as part of an international multicentric trial, we have been closing small-to-moderate atrial septal defects within the oval fossa using the Amplatzer Septal Occluder (ASO, AGA Medical). Methods: All patients with defects within the oval fossa deemed potentially suitable for transcatheter closure were investigated by transesophageal echocardiography with the aim of gaining extra information that might alter the decision to use the device to close the defect. Views were obtained in transverse and longitudinal planes, permitting measurements of the diameter of the defect, and its distance from the atrioventricular valves, coronary sinus, and pulmonary veins. Additionally, we sought to identify multiple defects, and to exclude sinus venosus defects. Results: Of 56 patients with left-to-right shunts, 41 (73.2%) were deemed suitable for closure with the Amplatzer Septal Occluder. All underwent the procedure successfully, with no complications. This includes 5 patients with multiple small defects that were sufficiently close to the main defect to be closed with a single device. Only two of these had been detected on the transthoracic study. In the remaining 15 of 56 patients, transcatheter closure was deemed unsuitable. In 9 patients, this was due to the limitation of the size of the device available during the period of study, this representing a relative contraindication. In the remaining 6 (10.7%), transcatheter closure was not performed because multiple defects were too far apart to be closed with a single device in 3 patients, two patients were noted to have a sinus venosus defect, and another was noted to have anomalous connection of the right upper pulmonary vein to the right atrium. Excluding patients contraindicated due to the size of the defect alone, transesophageal echocardiography provided extra information in one-tenth of our patients, which altered the decision regarding management. Conclusion: Transesophageal echocardiography is indispensable in the evaluation of patients undergoing transcatheter closure of atrial septal defect.

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