Beating Atrial Septal Defect Closure Monitored by Epicardial Real-Time Three-Dimensional Echocardiography Without Cardiopulmonary Bypass

Abstract

Background-We assessed the feasibility of beating atrial septal defect (ASD) closure monitored by real-time 3D echocardiography (RT3DE). Methods and Results-RT3DE was developed with prototype ultrasound equipment consisting of a high-speed 3D rendering unit with a frame rate of 5 to 10 frames/s. We also developed a prototype semiautomatic suture device and suture cutting system. In the experiment, 12 mongrel dogs were anesthetized, and after median sternotomy, the echo probe was applied directly to the surface of the right atrium. Three surgical maneuvers (balloon atrial septectomy, enlargement of the ASD, and ASD closure) were performed through the atrial port inserted into the right atrial appendage. The heart was then excised, and the area of the ASD measured by RT3DE was compared with its area measured directly. The ASD was successfully closed in all experimental animals except the first 2. Examination of the excised heart showed that none of the sutures were loose. The mean area of the ASD was 82.5Ϯ38.6 mm 2 when measured by RT3DE and 81.6Ϯ38.2 mm 2 when measured directly, and there was a significant correlation between the areas measured by RT3DE and those measured directly (echo measurementsϭ1.007ϫdirect measurementsϩ0.337; PϽ0.0001). A Bland-Altman analysis revealed close agreement between the results obtained by the 2 methods (7.807 mm 2 upper and Ϫ6.024 mm 2 lower limit of agreement). Conclusions-Introduction

Early Experience with Real-Time Three-Dimensional Echocardiographic Guidance of Right Ventricular Biopsy in Children

“…The use of epicardial 3DE via a rotational transducer and volume mode imaging has been demonstrated in assisting in the surgical closure of atrial septal defects off cardiopulmonary bypass in dogs. 22 In adult humans undergoing Amplatzer device occlusion of ASD, transesophageal 3DE image rendering (with postprocessing) has been shown to allow for superior delineation of ASD morphology when compared to transesophageal 2DE images. 23 (with postprocessing) was shown to be comparable to 2D TEE in determining maximal ASD diameter in patients undergoing device closure of their defects.…”

Safety and efficacy of atrial septal defect closure on normothermic on-pump beating heart

“…The scope of minimally invasive surgery is expanding, it includes not only cosmetic approach, but also beating heart surgery avoiding cardioplegia, port access to avoid sternotomy and recently experiments are underway using robotic technique under real time echocardiographic guidance to repair intracardiac defects completely avoiding cardiopulmonary bypass 13,14 .…”

Transesophageal Real-Time Three-Dimensional Echocardiography

“…The development of new surgical procedures in the future should enable operations like ASD occlusion or mitral valve repair on the beating heart under 3D echocardiographic control. Suematsu et al (15)(16)(17)(18) have demonstrated the feasibility of such procedures in their latest studies, whereby they performed the studies on the model with transthoracic RT3DE systems. As the authors noted, RT3D-TEE would be necessary for clinical applications.…”