Abstract
This study sought to evaluate the usefulness of real-time three-dimensional (3D) transesophageal echocardiography (TEE) to guide the repair of multiple atrial septal defects (ASDs). Of 212 consecutive patients with secundum ASD who were scheduled for transcatheter closure of their ASDs, 27 had multiple ASDs. These patients underwent two-dimensional (2D) transthoracic echocardiography, 2D TEE, and 3D TEE. Overall, 18 patients had two defects, and 9 patients had three or more defects. The latter group included three patients with multi-fenestrated defects. Optimal 3D images were obtained in 93 % of the patients. In patients with two defects, information on the positional relation of the defects was obtained using 2D TEE and 3D TEE in 71 and 94 % of patients, respectively (P = 0.22). The positional relations of the defects could not be evaluated with 2D TEE in patients with three or more defects, whereas it could be evaluated with 3D TEE in all of these patients (0 vs. 100 %, P = 0.008). In all patients, 3D TEE proved superior to 2D TEE for providing sufficient information (96 vs. 48 %, P = 0.002). Procedural success was obtained in 26 patients (96.3 %), without complications. Transcatheter closure of multiple ASDs under 3D TEE guidance is effective and safe. Real-time 3D TEE can provide useful information regarding complex ASD morphology. It can thus contribute to developing a successful treatment strategy, especially in patients with three or more defects.
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References
Mazic U, Gavora P, Masura J (2001) The role of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects by the Amplatzer septal occluder. Am Heart J 142:482–488
Butera G, Romagnoli E, Carminati M, Chessa M, Piazza L, Negura D, Giamberti A, Abella R, Pomè G, Condoluci C, Frigiola A (2008) Treatment of isolated secundum atrial septal defects: impact of age and defect morphology in 1,013 consecutive patients. Am Heart J 156:706–712
Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K, Amplatzer Investigators (2002) Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 39:1836–1844
Wang JK, Tsai SK, Wu MH, Lin MT, Lue HC (2004) Short- and intermediate-term results of transcatheter closure of atrial septal defect with the Amplatzer Septal Occluder. Am Heart J 148:511–517
Varma C, Benson LN, Silversides C, Yip J, Warr MR, Webb G, Siu SC, McLaughlin PR (2004) Outcomes and alternative techniques for device closure of the large secundum atrial septal defect. Catheter Cardiovasc Interv 61:131–139
Remadevi KS, Francis E, Kumar RK (2009) Catheter closure of atrial septal defects with deficient inferior vena cava rim under transesophageal echo guidance. Catheter Cardiovasc Interv 73:90–96
Szkutnik M, Masura J, Bialkowski J, Gavora P, Banaszak P, Kusa J, Zembala M (2004) Transcatheter closure of double atrial septal defects with a single Amplatzer device. Catheter Cardiovasc Interv 61:237–241
Awad SM, Garay FF, Cao QL, Hijazi ZM (2007) Multiple Amplatzer septal occluder devices for multiple atrial communications: immediate and long-term follow-up results. Catheter Cardiovasc Interv 70:265–273
Bramlet MT, Hoyer MH (2008) Single pediatric center experience with multiple device implantation for complex secundum atrial septal defects. Catheter Cardiovasc Interv 72:531–537
Mahadevan VS, Gomperts N, Haberer K, Silversides C, Benson LN, McLaughlin PR, Horlick EM (2009) Transcatheter closure of atrial septal defects with multiple devices in adults: procedural and clinical outcomes. Int J Cardiol 133:359–363
Butera G, Romagnoli E, Saliba Z, Chessa M, Sangiorgi G, Giamberti A, Cappato R, Bussadori C, Abella R, Pelissero G, Frigiola A, Carminati M (2010) Percutaneous closure of multiple defects of the atrial septum: procedural results and long-term follow-up. Catheter Cardiovasc Interv 76:121–128
Bartel T, Konorza T, Arjumand J, Ebradlidze T, Eggebrecht H, Caspari G, Neudorf U, Erbel R (2003) Intracardiac echocardiography is superior to conventional monitoring for guiding device closure of interatrial communications. Circulation 107:795–797
Taniguchi M, Akagi T (2011) Real-time imaging for transcatheter closure of atrial septal defects. Interv Cardiol 3:679–694
Lodato JA, Cao QL, Weinert L, Sugeng L, Lopez J, Lang RM, Hijazi ZM (2009) Feasibility of real-time three-dimensional transoesophageal echocardiography for guidance of percutaneous atrial septal defect closure. Eur J Echocardiogr 10:543–548
Taniguchi M, Akagi T, Watanabe N, Okamoto Y, Nakagawa K, Kijima Y, Toh N, Ohtsuki S, Kusano K, Sano S (2009) Application of real-time three-dimensional transesophageal echocardiography using a matrix array probe for transcatheter closure of atrial septal defect. J Am Soc Echocardiogr 22:1114–1120
Lee AP, Lam YY, Yip GW, Lang RM, Zhang Q, Yu CM (2010) Role of real time three-dimensional transesophageal echocardiography in guidance of interventional procedures in cardiology. Heart 96:1485–1493
Masura J, Gavora P, Padnar T (2005) Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders. J Am Coll Cardiol 45:505–507
Majunke N, Bialkowski J, Wilson N, Szkutnik M, Kusa J, Baranowski A, Heinisch C, Ostermayer S, Wunderlich N, Sievert H (2009) Closure of atrial septal defect with the Amplatzer septal occluder in adults. Am J Cardiol 103:550–554
Prokselj K, Kozelj M, Zadnik V, Podnar T (2004) Echocardiographic characteristics of secundum-type atrial septal defects in adult patients: implications for percutaneous closure using Amplatzer septal occluders. J Am Soc Echocardiogr 17:1167–1172
Opotowsky AR, Landzberg MJ, Kimmel SE, Webb GD (2009) Percutaneous closure of patent foramen ovale and atrial septal defect in adults: the impact of clinical variables and hospital procedure volume on in-hospital adverse events. Am Heart J 157:867–874
Silvestry FE, Kerber RE, Brook MM, Carroll JD, Eberman KM, Goldstein SA, Herrmann HC, Homma S, Mehran R, Packer DL, Parisi AF, Pulerwitz T, Seward JB, Tsang TS, Wood MA (2009) Echocardiography-guided interventions. J Am Soc Echocardiogr 22:213–231
Perk G, Lang RM, Garcia-Fernandez MA, Lodato J, Sugeng L, Lopez J, Knight BP, Messika-Zeitoun D, Shah S, Slater J, Brochet E, Varkey M, Hijazi Z, Marino N, Ruiz C, Kronzon I (2009) Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions. J Am Soc Echocardiogr 22:865–882
Cao Q, Radtke W, Berger F, Zhu W, Hijazi ZM (2000) Transcatheter closure of multiple atrial septal defects. Initial results and value of two- and three-dimensional transoesophageal echocardiography. Eur Heart J 21:941–947
Tamborini G, Pepi M, Susini F, Trabattoni D, Maltagliati A, Berna G, Onorato E, Bartorelli AL (2002) Comparison of two- and three-dimensional transesophageal echocardiography in patients undergoing atrial septal closure with the amplatzer septal occluder. Am J Cardiol 90:1025–1028
Light ED, Idriss SF, Wolf PD, Smith SW (2001) Real-time three-dimensional intracardiac echocardiography. Ultrasound Med Biol 27:1177–1183
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Taniguchi, M., Akagi, T., Kijima, Y. et al. Clinical advantage of real-time three-dimensional transesophageal echocardiography for transcatheter closure of multiple atrial septal defects. Int J Cardiovasc Imaging 29, 1273–1280 (2013). https://doi.org/10.1007/s10554-013-0212-z
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DOI: https://doi.org/10.1007/s10554-013-0212-z