Brief report

Two-dimensional echocardiographic and color doppler measurements of atrial septal defect, and comparison with the balloon-stretched diameter

To assess the long-term outcomes of device-based closure of atrial septal defects (ASDs) with no sizing balloon.

Two hundred and eighty-one consecutive patients (mean age 34±13 years, 178 women) underwent intracardiac echocardiography (ICE)-aided transcatheter closure of secundum ASDs over a 15-year period (September 2002 to March 2017). Sizing of the ASDs was calculated under ICE guidance (UltraICE, EP Technologies, Boston Scientific Corporation, San Jose, CA, USA) using the concept of “supportive rim” for ASDs without the aid of a sizing balloon. Follow-up was conducted by transoesophageal and transthoracic echocardiography.

The procedure was carried out successfully in all patients with 0% related mortality and 5.7% procedural complications. The Amplatzer ASD Occluder was implanted in 251 patients (89.3%, mean size 26.4±10.2 mm) whereas the Gore Cardioform was used in 30 patients (10.6%). Over 10.3±3 years of follow-up (range 1–15) 100% of patients were alive. The complete occlusion rate was 97.8%. No aortic or atrial free wall erosions, device thrombosis, or device frame fractures were detected during the follow-up period.

The present study suggested that ICE-guided closure of ASDs with current devices without sizing balloons is safe and effective with very low procedural and late complications even in the very long-term follow-up.

Real-time three-dimensional echocardiography, using both reconstruction methods and RT3D, has been used as an extra helping tool in several forms of congenital heart diseases. Our aim was to understand the relation of the ASD device to all surrounding structures by 3-dimensional echocardiography (3D).

This prospective study included 37 patients diagnosed as ASD secundum by transthoracic (TTE) and transesophageal echocardiography (TEE) referred for transcatheter closure from October 2013 to July 2016. Follow-up for 1 year using 2D and 3D-echocardiography was performed to assess the relations of the device to the surrounding structures.

Transcatheter ASD closure and echocardiographic examinations were successfully performed for all patients. By 3D echocardiography, 16 patients (43.24%) had their ASD device close to the aortico-mitral continuity plane without apparent regurgitation, while the rest of our patients (56.75%) the devices were away from this plane. The following variables were significantly different between the two groups; body surface area, atrioventricular rim (AV), device size, left disc size and ratio of left disc to interatrial septum. A cut-off AV rim length not less than 8 mm was found optimal to avoid device encroachment on the sensitive surrounding structures. New Formula was constructed to aid in device choice.

Use of 3D before and after ASD closure is of value to determine the device relation to the surrounding structures. AV rim by TEE is an important rim to avoid eventual encroachment on the mitral valve and aorta.

To describe and assess the use of the maximum colour flow diameter (CFDmax) in guiding transcatheter closure of atrial septal defects (ASDs) and compare it with the standard balloon sizing method.

Balloon sizing of ASDs has been the standard method of assessing the size of ASDs and selecting a closure device. However, overestimation of the defect by stretching it may result in complications such as erosion of the atrial wall or aortic root, particularly in the presence of a deficient aortic rim and the long-term effects of oversized defects are unknown.

Retrospective and prospective assessment of 115 consecutive patients who underwent ASD closure during three different time periods, when change in local practice occurred. Fifty patients underwent ASD closure with balloon sizing (period A), 15 with the aid of balloon sizing and additional estimation of the CFDmax (period B) and 50 with sole assessment of the CFDmax (period C).

The mean difference between the device used and the 2D defect size decreased from 6.9 to 5.1 mm (p < 0.01) and the percentage of device oversizing decreased from 38% to 31%. The complication rate decreased from 14% to 2%, (p = 0.03), whilst the procedure and screening times decreased from 70 to 43 min, (p < 0.001) and 14.2 to 8.4 min, (p < 0.001), respectively.

Transcatheter closure of ASDs guided solely by the CFDmax is feasible and safe and results in decreased procedure and screening times, whilst maintaining a low complication rate.

Transcatheter closure of a secundum atrial septal defect (ASD) has become an effective method for surgical treatment. In this study, we evaluated the feasibility and accuracy of intracardiac echocardiography (ICE) for sizing ASDs compared with conventional methods.

Between January 2004 and December 2006, 270 patients underwent transcatheter closure of secundum ASD by using septal occluders. For 142 patients, the procedure was guided by transesophageal echocardiography (TEE), and for 128 patients by ICE. We compared the maximal diameters of the ASDs obtained during angiocardiography, transthoracic echocardiography (TTE), ICE, and TEE with balloon-stretched sizes ascertained by using a sizing plate.

ASD diameters measured with the sizing plate were significantly correlated with those measured with ICE (r = 0.963), TEE (r = 0.912), angiography (r = 0.88), and TTE (r = 0.85). The predicted stretched diameter of the ASDs, i.e. (nonstretched diameter measured with ICE ×1.07) +3.23 mm, agreed well with that measured by using a sizing plate (Ri = 0.974).

ASD diameters measured with ICE correlated with sizing-plate measurements better than those determined with TEE, angiography or TTE.