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Echocardiographic Guidance During Placement of the Buttoned Double‐Disk Device for Atrial Septal Defect Closure
Author(s) -
MINICH L. LUANN,
SNIDER A. REBECCA
Publication year - 1993
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.1993.tb00072.x
Subject(s) - medicine , embolization , catheter , radiology , doppler echocardiography , cardiology , surgery , diastole , blood pressure
The usefulness of two‐dimensional and Doppler echocardiography during buttoned double‐disk device closure of an atrial septal defect was evaluated in 20 consecutive patients at the time of interventional catheterization. Transesophageal echocardiography was used in 11 patients (ages 5 to 62 years, weights 20 to 91 kg). Because of the size of the available transesophageal echo probe, transthoracic echocardiography was used in the remaining 9 patients (ages 4 to 5.5 years, weights 14 to 21 kg). In the transesophageal echo group, 1 patient was found to have no atrial septal defect despite a previous diagnosis by transthoracic echocardiography, 3 patients had atrial septal defects too large for closure despite attempts in 2, and 7 patients had transesophageal echo guided device placement. All of these 7 patients had small residual shunts by color Doppler, 2 had unusual arm positions, and 2 had surgical removal of the device due to embolization to the pulmonary artery in 1 and failure to obtain close approximation of the occluder and counteroccluder in 1. In the transthoracic echo group, 2 patients had atrial septal defects too large for closure, 1 patient had no femoral venous access, and 6 patients had transthoracic echo guided device placement. All of these 6 patients had small residual shunts by color Doppler and 3 of the 6 had unusual arm positions. For atrial septal defect sizing, transesophageal echo measurements correlated with catheter balloon size more closely than did transthoracic echo measurements (r 2 = 0.97 vs 0.86). Echocardiography was particularly useful for sizing the defect in two orthogonal views (n = 18), sizing total atrial septal length to determine maximum usable device size (n = 15), imaging septal rims (n = 19), determining effectiveness of balloon occlusion for sizing (n = 16), placement of occluder and counteroccluder (n = 15), detecting residual shunts (n = 15), and detecting unusual arm positions with or without new‐onset valve regurgitation (n = 5). Thus, echocardiographic imaging is an essential component of atrial septal defect closure during cardiac catheterization. (ECHOCARDIOGRAPHY, Volume 10, November 1993)