Introduction
Unrepaired secundum ASD is the commonest congenital defect seen in adult congenital heart disease population. Transcatheter closure of secundum ASD has been proven safe, very effective and become preferred method of choice for the treatment. It avoids the prolonged hospital stay and the unpreferred sternotomy that are associated with surgical closure. Accurate assessment of the ASD shape and size is the cornerstone of a successful transcatheter closure of an ASD. Both under sizing and oversizing the defect could lead to serious complications. At present balloon sizing is the preferable technique adopted by most of the cardiac interventionists to assess the defect size and select the device. Although it proved to be a reliable method, balloon sizing prolongs exposure to fluoroscopy and adds cost. Some authors have mentioned that an overstretched balloon can lead to distortion of the defect margins leading to enlarging the defect size and probably losing a pre-existing tiny rim (Ooi et al., 2016).
Three dimensional transesophageal echocardiography (3D-TEE) is a promising tool to guide different cardiac interventional procedures. It is widely available, easy and reproducible imaging modality that has the ability to overcome geometric assumption which is considered one of the major limitations of the two dimensional echocardiography.(Balzer et al., 2013)
Nowadays, image acquisition and processing using the 3D TEE have become more applicable during different cardiac interventional procedures (references) (Balzer et al., 2013)The 3D TEE obtained en face view of interatrial septum provides accurate information about the number, shape and size of the defect. Moreover, it provides additional valuable information about the relation between the defect and the surrounding structures and confirms the adequacy of the surrounding rims. (Balzer et al., 2013)
We conducted this retrospective analysis to assess the efficacy and reliability of 3D TEE as a reproducible imaging modality to accurately determine the size of ASD and selection of the device.