Background:
Intracardiac echocardiography (ICE) is the preferred method for deployment of Amplatzer septal occluder devices (ASOD) in patients with atrial septal defect (ASD). Because ICE is costly and not widely available, 2D transesophageal echocardiography (2D-TEE) is often used instead. However, ASDs can have complex oval shapes that may not be well characterized with 2D imaging. We hypothesized that a new real-time 3D TEE (RT3D-TEE) probe could provide dynamic en-face visualization of the ASD and thus allow precise assessment of ASD dimensions.
Aims:
To determine the feasibility of using RT3D-TEE in the guidance of ASOD deployment in patients with ASD, and
to compare the size of ASD and the occluding balloon waist obtained using RT3D-TEE against ICE and 2D-TEE.
Methods:
8 consecutive patients with ostium secundum ASD (age 36±11 yrs) underwent ASOD placement under general anesthesia. Biplane 2D-TEE, RT3D-TEE and ICE images were acquired (Philips iE33) sequentially throughout ASOD placement. Measurements were obtained on-line.
Results:
Closure was successful in all patients without complications. RT3D-TEE was feasible yielding high quality images suitable for measurements (Table). ASD size by RT3D-TEE differed by >1mm from 2D-TEE and ICE in 2 and 3 patients respectively in the long axis view and in 3 and 4 patients in the short axis view. Balloon waist size was 25.5 ± 6.7 (16–37) by 3D TEE and 24.7 ± 6.5 (15–35) by ICE.
Conclusions:
RT3D-TEE can be used for guidance of ASOD deployment with the advantage of improved ability compared to 2D-TEE and ICE to visualize the true en-face views, from which accurate measurements of ASD dimensions can be made for device selection.
Assessment of atrial septal defect using 2D or real-time 3D transesophageal echocardiography and outcomes following transcatheter closure
