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European Journal of Echocardiography Advance Access published online on September 15, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jep116
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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, safety, and efficacy of real-time three-dimensional transoesophageal echocardiography for guiding device closure of interatrial communications: initial clinical experience and impact on radiation exposure

Jan Balzer1,*,{dagger}, Silke van Hall2,{dagger}, Tienush Rassaf1, Yang-Chul Böring1, Andreas Franke2, Roberto M. Lang3, Malte Kelm1 and Harald P. Kühl2

1 Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, D-40225 Düsseldorf, Germany
2 Department for Cardiology and Pulmonology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
3 Noninvasive Cardiac Imaging Laboratories, University of Chicago Medical Center, Chicago, IL, USA

Received 20 May 2009; accepted after revision 20 August 2009.

* Corresponding author. Tel: +49 211 8118800; fax: +49 211 8118812. E-mail address: jan.balzer{at}med.uni-duesseldorf.de


  Abstract

Aims: Our aim was to assess the feasibility and safety of real-time (RT) three-dimensional (3D) transoesophageal echocardiography (TEE) for guiding transcatheter closure of interatrial communications and to evaluate its additional benefit over conventional 2D TEE in reducing radiation exposure for the patient.

Methods and results: Twenty-five patients undergoing device closure of their interatrial defect had the procedure guided by fluoroscopy, 2D TEE, and RT 3D TEE. We retrospectively compared this group with a historical control group in which interventional guidance was performed using fluoroscopy and 2D TEE alone. The application of RT 3D TEE allowed safe device deployment in all patients without any complications, resulting in a reduction of mean fluoroscopy time (10 ± 6 to 6 ± 4 min, P < 0.01), mean dose area product (DAP) (964 ± 628 to 535 ± 464 cGy cm2, P < 0.01), and mean DAP per individual body surface area (494 ± 317 to 273 ± 221 cGy cm2/m2, P < 0.01).

Conclusion: RT 3D TEE as an adjunct to 2D TEE is a feasible and safe tool to guide transcatheter device closure of interatrial communications, resulting in a reduction of radiation exposure. These data indicate that RT 3D TEE can be used to safely monitor interatrial defect closure in clinical routine.

Keywords: RT 3D TEE; Transcatheter device closure; Interatrial communications

{dagger} Both authors contributed equally to this work.


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