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European Journal of Echocardiography Advance Access originally published online on January 29, 2009
European Journal of Echocardiography 2009 10(4):543-548; doi:10.1093/ejechocard/jen337
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Feasibility of real-time three-dimensional transoesophageal echocardiography for guidance of percutaneous atrial septal defect closure

Joseph A. Lodato1,*, Qi Ling Cao2, Lynn Weinert1, Lissa Sugeng1, John Lopez1, Roberto M. Lang1 and Ziyad M. Hijazi2

1 University of Chicago Medical Center, 5841 South Maryland Ave. MC 5084, Chicago, IL 60637, USA
2 Rush University Medical Center, Chicago, IL, USA

Received 21 August 2008; accepted after revision 29 December 2008; online publish-ahead-of-print 29 January 2009.

* Corresponding author. Tel: +1 773 702 1842; fax: +1 773 702 1034. Email address: jlodato{at}medicine.bsd.uchicago.edu


  Abstract

Aims: Intracardiac echocardiography (ICE) and two-dimensional transoesophageal echocardiography (2D TEE) are used in most centres for guiding transcatheter atrial septal defect (ASD) closure. ASDs have complex shapes that are not well characterized with 2D imaging. Real-time 3D TEE (RT3D TEE) provides en-face visualization of the ASD, allowing precise assessment of ASD dimensions. Accordingly, our aims were (i) to determine the feasibility of RT3D TEE to guide ASD closure and (ii) to compare ASD and balloon dimensions (BDs) using RT3D TEE vs. ICE and 2D TEE.

Methods and Results: Thirteen patients with ostium secundum ASD underwent transcatheter ASD closure. 2D TEE, RT3D TEE, and ICE images were acquired sequentially. RT3D TEE was feasible in all patients. Comparing RT3D TEE and 2D imaging, the mean difference in long-axis dimension was +0.5 mm (P= NS for both), and –1.4 mm in short-axis (2D TEE, P < 0.05; ICE, P = 0.06). BD was greater with 3D TEE vs. ICE (+0.9 mm).

Conclusion: RT3D TEE can be used to guide transcatheter ASD closure with the advantages of lower cost than ICE, and ability to visualize en-face views of the ASD. ASD and BD as measured by RT3D TEE differ when compared with 2D imaging.

Keywords: Atrial septal defect; Three-dimensional transoesophageal echocardiography; Intracardiac echocardiography; Amplatzer septal occluder


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