Patients and methods:
We retrospectively reviewed thirty-eight patients who underwent a
transcatheter closure of atrial septal defect from November 2018 to
December 2019. In this study 28 patients were done at The Royal Brompton
Hospital in London and 10 patients were done at The Children Hospital,
Mansoura University, Egypt. There was no patients with significant
residual shunts. However, we excluded two patients one of them had a
major complication (device dislodgement) and the other one had multiple
defects. A total of 36 patients composed study group.
All our patients had a percutaneous ASD closure under 3D TOE guidance as
the presence of haemodynamically significant ASD and suitable anatomic
characters. The device selection was done according to balloon sizing
using the flow stopping technique.
We considered a procedure to be successful in all patients with no
residual shunt or with residual shunt of less than 2 mm and without
encroachment on the surrounding structures or other major complications
(device dislodgement) Subsequently, we assumed that the device size was
appropriate among those patients.
Echocardiographic assessment was conducted in all patients, using an IE
33 Philips machine and TEE probe X7-2t.
From transthoracic echocardiogram both color and 2D images of ASD were
obtained in the standard subcostal view and the modified apical four
chamber view, maximal dimensions of the ASD were measured.
During the transesophageal Echocardiography the ASD diameters were
assessed using the standard views including a mid-oesophageal
four-chamber view (0), a short-axis view (35 – 60) and a long-axis view
(90 – 130). Continuous rotation was performed to track the maximal
diameter and both colour and 2D pictures were obtained.
The 3D images were obtained in the mid-oesophageal bicaval view at
around 90 degrees, the 3D zoom mode was activated and the zoom box was
optimized in the lateral plane to include the opening of the SVC and
IVC. The whole septum was included by optimizing the depth settings. A
full volume for the IAS was obtained and then rotated anticlockwise for
90 degrees and turn the image leftwards, the SVC opening is directed
upwards. This was considered anatomically oriented en face view of ASD
from the RA perspective. Gain optimization was done to remove all blood
shadows and optimise the image for accurate identification of defect
border then the image was acquired.
An offline MPR was performed moving each axis to obtain an image, which
included the whole ASD. Measurements of the minimal and maximal
diameters were performed using two axes on the 2D images obtained by MPR
(figure 1)
The maximal diameters were all compared with the device size. Three
types of devices were encountered in this study which were Occulotech,
Hyperion and Amplatzer according to the availability of the selected
size.