Impact of dynamic 3D transoesoesophageal echoardiography in the assessment of atrial septal defects and occlusion by the double-umbrealla device(CardioSEAL)

Abstract

Occlusion of the atrial septal defects in the oval fossa by interventional catheterization has progressed, but still has limitations. Three-dimensional (3D) echocardiography can provide unique views unavailable by cross-sectional imaging. The objective of this study was to define the clinical application of 3D echocardiography in the assessment and monitoring of transcatheter occlusion of atrial septal defects. Three-dimensional echocardiography was attempted prior to occlusion of atrial septal defects in 41 patients (median age 8.6 years). Serial cross-sectional images were acquired by multiplane transoesophageal echocardiography and displayed by means of computer reconstruction. Dynamic 3D echocardiographic images of defects in the oval fossa were obtained in 40 of 41 patients (98%). Volume-rendering demonstrated the anterosuperior rim in 36 (90%) and the inferoposterior rim in 24 (60%), but failed to reveal small additional fenestrations in six. Sizes measured by 3D echocardiography were significantly larger than those provided by cross-sectional transoesophageal echocardiography (p=0.007), but differed little from those obtained with balloon sizing (p=0.6). After occlusion, 3D echocardiography showed positions of all arms of the device in 20 of 24 cases. Location of any protruding arms, or residual defects, were also clearly revealed. Three-dimensional images obtained in 12 patients during deployment of the double-umbrella device were useful in monitoring its position (single-frame) and for explaining the mechanism of protrusion. Current 3D echocardiography provides clinically relevant information for selection of patients for closure of atrial septal defects by interventional catheterization and when monitoring during implantation. Information obtained by this technique can clarify the mechanism of deployment of the device and closure of the defect, therefore influencing outcomes.

Transesophageal Echocardiography for Quantifying Size of Patent Foramen Ovale in Patients With Cryptogenic Cerebrovascular Events

“…19,20 Recently, 3-dimensional echocardiography has been shown to be superior to 2D echocardiography in measurement of atrial septal defects. 21,22 It remains to be seen whether this technique can provide additional information on PFO quantification.…”

Direct En Face Imaging of Secundum Atrial Septal Defects by Velocity-Encoded Cardiovascular Magnetic Resonance in Patients Evaluated for Possible Transcatheter Closure

“…19,30 For instance, ASD maximal diameter appears to be more accurately measured by 3-dimensional TEE than 2-dimensional TEE compared with intraoperative measurements 31 or balloon sizing. 32 Additionally, several groups 20,33,34 have reported that 3-dimensional TEE is superior to 2-dimensional TEE in consistently detecting the features of complex secundum defects (eccentrically shaped, multiple, atypical location, etc). Given that even after screening with 2D TEE 10% of patients have an attempted but ultimately unsuccessful transcatheter closure, 35 the implication is that clinical management would be improved by the use of 3-dimensional imaging.…”

“…The inferoposterior portion of the interatrial septum is poorly visualized as a result of artifactual dropout; small fenestrations may be missed because of inadequate spatial resolution; and depending on patient compliance, movement can result in image misalignment and reconstruction artifacts. 32,33,36 On the other hand, CMR also has some limitations. In the present study, ASD was ruled out correctly by en face veCMR in the 5 patients with PFO; however, in only 3 patients was the PFO detected by CMR (first-pass perfusion imaging).…”

New Three-Dimensional Echocardiographic System Using Digital Radiofrequency Data—Visualization and Quantitative Analysis of Aortic Valve Dynamics With High Resolution

“…1,2 The spatial imaging of cardiac structures is especially important in the planning and performance of surgical and catheter interventional procedures. 3,4 In addition, new possibilities of quantitative analysis, such as the determination of ventricular size and function, are also offered. 5,6 Establishing 3D echocardiography as a clinical routine procedure requires, however, further technical improvements in spatial and temporal image resolution.…”