Perioperative Assessment and Clinical Outcomes of Percutaneous Atrial Septal Defect Closure with Three-Dimensional Transesophageal Echocardiography

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2024 Aug 29

PMID 39202243

Authors

Ibrahim Sarac

Oguzhan Birdal

Affiliations

Soon will be listed here.

Abstract

Background/objectives: To close the atrial septal defect (ASD) with the transcatheter method, correctly defining the defect and selecting the appropriate closure device size are the most critical steps for the procedure's success. Although ASD can be successfully closed under the guidance of three-dimensional (3D) transesophageal echocardiography (TEE) and two-dimensional (2D) TEE, measurement comparisons between different types of defects are still needed.

Methods: Our study was designed retrospectively. Sixty-one patients who underwent transcatheter ASD closure with 2D TEE and 3D TEE between 2020 and 2024 were included. The patients were divided into three groups according to the defect shape: circular, oval, and complex; and the measurement results, perioperative process, and clinical outcomes were compared in each group.

Results: The average age of the patients was 35.05 ± 13.87 years, and 41 (67.2%) were women. The average follow-up period of the patients was 15.3 ± 9.18 months. No statistical significance was observed in the comparison of measurements obtained with 3D TEE and 2D TEE in the circular and oval defect groups. The differences between the minimum defect diameters of complex defects measured by 2D TEE and 3D TEE (: 0.037), IVC rims ( < 0.001), aortic rims (: 0.012), and the differences between implanted device dimensions and the maximum defect diameters measured by both methods were compared; statistical significance was observed (: 0.025).

Conclusions: In circular and non-complex oval defects, it has been observed that the size of the closure device selected with 2D TEE or 3D TEE is optimal, and the procedure is practical and feasible. While the closure of complex ASDs with 3D TEE provides reliable and optimal results, using only 2D TEE in complex ASDs may lead to selecting a smaller-sized device.

References

Kitakata H, Itabashi Y, Kanazawa H, Miura K, Kimura M, Shinada K . Appropriate device selection for transcatheter atrial septal defect closure using three-dimensional transesophageal echocardiography. Int J Cardiovasc Imaging. 2020; 37(4):1159-1168. DOI: 10.1007/s10554-020-02095-x. View

Fraisse A, Latchman M, Sharma S, Bayburt S, Amedro P, Di Salvo G . Atrial septal defect closure: indications and contra-indications. J Thorac Dis. 2018; 10(Suppl 24):S2874-S2881. PMC: 6174144. DOI: 10.21037/jtd.2018.08.111. View

Quek S, Wu W, Chan K, Ho T, Yip W . Transcatheter closure of atrial septal defects--is balloon sizing still necessary?. Ann Acad Med Singap. 2010; 39(5):390-3. View

Shrivastava S, Shrivastava S, Allu S, Schmidt P . Transcatheter Closure of Atrial Septal Defect: A Review of Currently Used Devices. Cureus. 2023; 15(6):e40132. PMC: 10329454. DOI: 10.7759/cureus.40132. View

Stout K, Daniels C, Aboulhosn J, Bozkurt B, Broberg C, Colman J . 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018; 73(12):1494-1563. DOI: 10.1016/j.jacc.2018.08.1028. View

Roberson D, Cui V . Three-dimensional transesophageal echocardiography of atrial septal defect device closure. Curr Cardiol Rep. 2014; 16(2):453. DOI: 10.1007/s11886-013-0453-4. View

Lang R, Badano L, Tsang W, Adams D, Agricola E, Buck T . EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging. 2012; 13(1):1-46. DOI: 10.1093/ehjci/jer316. View

Song J, Lee S, Baek J, Shim W, Choi E . Outcome of transcatheter closure of oval shaped atrial septal defect with amplatzer septal occluder. Yonsei Med J. 2013; 54(5):1104-9. PMC: 3743189. DOI: 10.3349/ymj.2013.54.5.1104. View

Carlson K, Justino H, OBrien R, Dimas V, Leonard Jr G, Pignatelli R . Transcatheter atrial septal defect closure: modified balloon sizing technique to avoid overstretching the defect and oversizing the Amplatzer septal occluder. Catheter Cardiovasc Interv. 2005; 66(3):390-6. DOI: 10.1002/ccd.20443. View

10.

Majunke N, Bialkowski J, Wilson N, Szkutnik M, Kusa J, Baranowski A . Closure of atrial septal defect with the Amplatzer septal occluder in adults. Am J Cardiol. 2009; 103(4):550-4. DOI: 10.1016/j.amjcard.2008.10.018. View

11.

Deng B, Chen K, Huang T, Wei Y, Liu Y, Yang L . Assessment of atrial septal defect using 2D or real-time 3D transesophageal echocardiography and outcomes following transcatheter closure. Ann Transl Med. 2021; 9(16):1309. PMC: 8422086. DOI: 10.21037/atm-21-3206. View

12.

Suchon E, Pieculewicz M, Tracz W, Przewlocki T, Sadowski J, Podolec P . Transcatheter closure as an alternative and equivalent method to the surgical treatment of atrial septal defect in adults: comparison of early and late results. Med Sci Monit. 2009; 15(12):CR612-7. View

13.

Kijima Y, Akagi T, Nakagawa K, Takaya Y, Oe H, Ito H . Three-dimensional echocardiography guided closure of complex multiple atrial septal defects. Echocardiography. 2014; 31(10):E304-6. DOI: 10.1111/echo.12731. View

14.

Harikrishnan S, Narayanan N, Sivasubramonian S . Sizing balloon-induced tear of the atrial septum. J Invasive Cardiol. 2005; 17(10):546-7. View

15.

Alsaileek A, Omran A, Godman M, Najm H . Echocardiographic visualization of laceration of atrial septum during balloon sizing of atrial septal defect. Eur J Echocardiogr. 2006; 8(2):155-7. DOI: 10.1016/j.euje.2005.12.013. View

16.

Assenza G, Spinardi L, Mariucci E, Balducci A, Ragni L, Ciuca C . Transcatheter Closure of PFO and ASD: Multimodality Imaging for Patient Selection and Perioperative Guidance. J Cardiovasc Dev Dis. 2021; 8(7). PMC: 8306204. DOI: 10.3390/jcdd8070078. View

17.

Hascoet S, Hadeed K, Marchal P, Dulac Y, Alacoque X, Heitz F . The relation between atrial septal defect shape, diameter, and area using three-dimensional transoesophageal echocardiography and balloon sizing during percutaneous closure in children. Eur Heart J Cardiovasc Imaging. 2015; 16(7):747-55. DOI: 10.1093/ehjci/jeu316. View

18.

Mani A, Harikrishnan S, Sasidharan B, Ganapathi S, Valaparambil A . Utility of 3D Echocardiography for Device Sizing During Transcatheter ASD Closure: A Comparative Study. J Cardiovasc Imaging. 2023; 31(4):180-187. PMC: 10622641. DOI: 10.4250/jcvi.2023.0039. View

19.

Taha F, Elshedoudy S . Role of 3D transesophageal echocardiography in transcatheter closure of atrial septal aneurysms. Echocardiography. 2019; 36(10):1884-1894. DOI: 10.1111/echo.14482. View

20.

Boon I, Vertongen K, Paelinck B, Demulier L, Van Berendoncks A, De Maeyer C . How to Size ASDs for Percutaneous Closure. Pediatr Cardiol. 2017; 39(1):168-175. DOI: 10.1007/s00246-017-1743-1. View