Closure of Patent Foramen Ovalis and Atrial Septal Defect

  • Francesco Fulvio Faletra
  • Gila Perk
  • Natesa G. Pandian
  • Hans-Joachim Nesser
  • Itzhak Kronzon


The atrial septum (AS) is bordered anteriorly by the aortic root and posteriorly by the posterior atrial walls. Because the left atrium is posterior and to the left of the right atrium, the plane of the AS is oriented obliquely and runs from a right posterior to a left anterior position. The best way to visualize the AS by ultrasound is by transesophageal echocardiography (TEE). However, two-dimensional (2D) TEE planes always intersect the septum perpendicular to its surface. Consequently, although this structure is anatomically a fibromuscular membrane dividing the atrial cavities, it is imaged as a linear structure, which may be thicker around the fossa ovalis (FO) and thinner at the level of the floor. Conversely, a unique quality of three-dimensional (3D) TEE is the ability to image internal surfaces of the heart from an en face perspective. Thus, both the left and the right sides of the AS can be visualized en face as they appear in anatomic specimens. The proximity of the transesophageal transducer to the AS (and the nearly perpendicular angle of incidence of the ultrasound beam), the use of transducers at higher frequencies, and, finally, the lack of interference from bones and lung allow the AS to be seen in 3D images of unprecedented quality. This chapter describes the acquisition of real-time (RT) 3D TEE images of the AS, the normal 3D TEE appearance of both left and right surfaces of the AS, the appearance of patent foramen ovalis (PFO) and secundum atrial septal defects (ASDs) on 3D TEE images, and, finally, the use of 3D TEE to guide percutaneous closure procedures for both PFOs and ASDs.


Atrial Septum Atrial Wall Percutaneous Closure Septum Primum Fossa Ovalis 
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Supplementary material

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Video 2.1 Anatomy of the atrial septum: atrial septum with the fossa ovalis and surrounding rim from the left and right side (AVI 22623 kb)
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Video 2.2 Atrial septal defect (ASD) from the left perspective. The dynamic changes in size are evident. ASD appears smaller in diastole and larger in systole (AVI 1521 kb)
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Video 2.3 ASD from the right perspective (AVI 1480 kb)
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Video 2.4 Two ASD defects of different size from the left and right perspective (AVI 24545 kb)
Video 2.5

3D TEE movie of PFO occlusion from lateral perspective (AVI 13830 kb)

Suggested Reading

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  7. Vettukatti JJ. Three dimensional echocardiography in congenital heart disease. Heart. 2012;98:79–88.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Francesco Fulvio Faletra
    • 1
  • Gila Perk
    • 2
  • Natesa G. Pandian
    • 3
  • Hans-Joachim Nesser
    • 4
  • Itzhak Kronzon
    • 2
  1. 1.Department of CardiologyCardiocentro TicinoLuganoSwitzerland
  2. 2.Non-Invasive CardiologyLenox Hill HospitalNew YorkUSA
  3. 3.Tufts University School of MedicineBostonUSA
  4. 4.Department of Medicine ElisabethinenTeaching HospitalLinzAustria

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