The relation between atrial septal defect shape, diameter, and area using three-dimensional transoesophageal echocardiography and balloon sizing during percutaneous closure in children

Abstract

A trans-catheter closure of an atrial septal defect (ASD) is efficient. Balloon sizing (BS) during the catheterization leads to an overestimation of ASD size. Three-dimensional transoesophageal echocardiography (3D-TEE) allows the ASD morphology to be assessed comprehensively. The aim of this study was to assess the relationships between the shape and the measurements of ASDs by 2D-, 3D-TEE, and BS in children. Methods and resultsThirty children who underwent percutaneous closures of a single ASD were enrolled. ASD diameters were measured by 2D-transthoracic echocardiography (TTE), 2D-TEE, 3D-TEE and compared with BS. The ASD area was measured on 3D-TEE images after multi-planar reconstruction. ASD was estimated as round or oval on 3D-TEE 'en-face' view. 2D-TTE, 2D-TEE, and 3D-TEE max ASD diameters were well correlated with BS (r ¼ 0.75; 0.80, and 0.85, respectively). Mean diameters were all significantly smaller than the mean BS. The mean difference between the balloon area and 3D-TEE area was 1.6 + 1.4 cm 2 (P , 0.0001). The mean difference between BS and 3D-TEE max diameters was higher in round ASDs than in oval ASDs (4.0 + 3.3 vs. 1.1 + 3.3, P ¼ 0.02). With multivariate linear regression analysis, two formulas were built to predict BS. The first model was BS ¼ 1.07 × 3D-TEE max 2 3.1 × ASDshape + 3. The ASD shape was 0 for round and 1 for oval ASDs. A second model was BS ¼ 4.5 × ASDarea + 11.5. ConclusionThe ASD shape is accurately estimated by 3D-TEE and influences the relationship between echocardiographic measurements and BS. The ASD shape, its maximal diameter and the area assessed by 3D-TEE may be sufficient to determine the device size without BS in children.--

Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children

“…Our results underline the pivotal role of the method of choice of the device, which is closely related to procedural success and complication rate. 2D-TEE and 2D-TTE images underestimate the ASD maximal size compared to balloon-sizing (5,(32)(33)(34). In our experience, a balloon calibration was performed in all cases minimizing the impact of the echo technique on the device choice.…”

“…A careful assessment of ASD size, morphology and rims is the key-step for device selection. Trans-esophageal echocardiography (TEE) or intracardiac echocardiography (ICE) are widely used to guide the procedure (4,5). However, TEE use may lead to oropharyngeal and oesophageal traumas (6)(7)(8), and ICE is expensive and require an additional large venous access (9).…”

Clinical Application of 3-Dimensional Echocardiography in the USA

“…170 Live/real-time 3D TEE can visualize an ASD with better imaging quality than transthoracic 3D echocardiography ( Figure 6) and can assist in and confirm the successful closure of the ASD, demonstrating the clinical feasibility of this echo method. 176, 177 Thus, applications of real-time 3D TEE on the interatrial septum and/or ASD ( Figure 6) and devise closure have been reported repeatedly. 176-180 3D TEE showed greater values for the maximal ASD size than did 2D echo because 3D echo can visualize the entire shape of ASD clearly whereas 2D echo cannot.…”

Three‐dimensional printing assisted transcatheter closure of atrial septal defect with deficient posterior–inferior rim

“…In patients for transcatheter closure of secundum atrial septal defect (ASD), the surrounding rim dimension is a crucial parameter that determines the stability of the device . However, some large ASDs are usually associated with deficient posterior–inferior rim, which makes the device implantation difficult and increases the risk for device embolization .…”