Sizing of Atrial Septal Defects by Intracardiac Echocardiography for Device Closures

Abstract

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

Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion

“…In our study, this technique was used in diagnosis and to guide device deployment in all patients. Although Jen-Chung Chien reported that transesophageal echocardiography (TEE)'s assessment of the size, number and position of the defects prevails over traditional TTE [20], in our opinion, with the experienced operators, TTE is a reliable method in quantitating ASD diameters and circumferential margins. The residual septum around the ASD can be accurately measured ultrasonically and the distance from the edge of the ASD to superior vena cava, right pulmonary vein, aortic root, atrioventricular valves, and coronary sinus can be reasonably obtained, especially the inferior vena cava rim [24].…”

Percutaneous ASD Closure in a Large Australian Series: Short- and Long-Term Outcomes

“…The majority of cases were performed under TOE guidance (61%) followed by ICE (39%), which has been reported to show superior imaging of the right atrium and increases the detection of additional atrial shunts [11,12]. Once intra cardiac echo with Doppler (ICE) capacity became available, this was the preferred imaging modality for ASDs and PFOs as it provides excellent imaging in the near field and there is no requirement for oesophageal intubation and general anaesthesia.…”

A comparison between size of the occluder device and two-dimensional transoesophageal echocardiographic sizing of the ostium secundum atrial septal defect : cardiovascular topics

“…Stretched balloon diameter (SBD) and balloon occlusive diameter (BOD) are two measurements that have long been used by interventionalists in the selection of an appropriate device size for implantation 17-19. However the balloon sizing method has its disadvantages.…”

“…Inflation of the balloon may enlarge the defect, cause arrhythmias, or lead to hypotension due to decreased diastolic filling 21,22. Some investigators therefore consider this cumbersome procedure unnecessary7,23 and prefer less-invasive measuring methods in the selection of the size of the ASD closure device 10,14,19,24…”

“…TEE is crucial for the assessment of ASD morphology 19,23,25. Many studies have indicated the highly reliable role of TEE in the prediction of BOD, SBD and device size 10,15,17,19…”