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European Journal of Echocardiography Advance Access originally published online on June 10, 2008
European Journal of Echocardiography 2008 9(6):822-823; doi:10.1093/ejechocard/jen178
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Real-time 3D transoesophageal echocardiography for guiding Amplatzer septal occluder device deployment in an adult patient with atrial septal defect

Philippe Acar*, Pierre Massabuau and Meyer Elbaz

Congenital Heart Unit, Rangueil Hospital, Toulouse, France

Received 11 March 2008; accepted after revision 18 May 2008; online publish-ahead-of-print 10 June 2008.

* Corresponding author: Cardiologie Pédiatrique, Hôpital des enfants, 330 Av de grande-bretagne, Toulouse 31130, France. Tel: +33 5 34 55 87 15; fax: +33 5 34 86 63. E-mail address: acar.p{at}chu-toulouse.fr


   Abstract
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 Abstract
Supplementary data
 
A 32-year-old male with secundum atrial septal defect underwent percutaneous transcatheter occlusion. The procedure was performed under general anaesthesia and guided by real-time 3D transoesophageal echocardiography (TEE) (i.e. 33, matrix probe 2–7 MHz). The device delivery system was advanced through a femoral vein catheter and placed in the left upper pulmonary vein. A 3D left atrial view was instantaneously obtained. The size of the septal occluder was chosen according to the balloon catheter method. A 12 mm Amplatzer device was deployed under real-time 3D TEE without fluoroscopy. The 3D views depicted the progression of the left-side disc from the left atrial cavity towards the septum. Left and right atrial views demonstrated the perfect application of the device to the atrial septum. Keeping a steady traction on the delivery rod, the right-side disc of the device was then deployed on the right atrial side of the defect. A pushing and pulling of the delivery cable ensured that the device was in a secure and stable position. Absence of periprothetic residual shunt was assessed by 2D colour Doppler TEE before release. Transthoracic echocardiography performed the day after ensured the right position of the device. Real-time 3D TEE is a very recent technology allowing on-line guidance of atrial septal occluder device deployment; such imaging should increase delivery safety and decrease fluoroscopy time.

Keywords: 3D echocardiography; Atrial septal defect; Transoesophageal echocardiography; Amplatzer occluder

A 32-year-old male with secundum atrial septal defect underwent percutaneous transcatheter occlusion. The procedure was performed under general anaesthesia and guided by real-time 3D transoesophageal echocardiography (TEE) (i.e. 33, matrix probe 2–7 MHz, Philips, Andover MA, US). The device delivery system was advanced through a femoral vein catheter and placed in the left upper pulmonary vein. A 3D left atrial view was instantaneously obtained (Figure 1). The size of the septal occluder was chosen according to the balloon catheter method. A 12 mm Amplatzer device (AGA Medical, Golden Valley, MN, USA) was deployed under real-time 3D TEE without fluoroscopy. The 3D views depicted the progression of the left-side disc from the left atrial cavity towards the septum (Figure 2). Left and right atrial views demonstrated the perfect application of the device to the atrial septum (see Supplementary data online, Videos 1 and 2). Keeping a steady traction on the delivery rod, the right-side disc of the device was then deployed on the right atrial side of the defect. A pushing and pulling of the delivery cable ensured that the device was in a secure and stable position. Absence of periprothetic residual shunt was assessed by 2D colour Doppler TEE before release. Transthoracic echocardiography performed the day after ensured the right position of the device.


Figure 1
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  		Figure 1 Left atrial view of the atrial septal defect. The defect had an ovale shape with the transseptal sheat at the top.

 


Figure 2
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  		Figure 2 (A–C) Left atrial views of the Amplatzer device. The deployment and the progression of the left-side disc were depicted in real-time by 3D transoesophageal echocardiography.

 
Real-time 3D TEE is a very recent technology allowing on-line guidance of atrial septal occluder device deployment; such imaging should increase delivery safety and decrease fluoroscopy time.


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 Supplementary data
 
Supplementary data are available at European Journal of Echocardiography online.


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This article has been cited by other articles:


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J. A. Lodato, Q. L. Cao, L. Weinert, L. Sugeng, J. Lopez, R. M. Lang, and Z. M. Hijazi
Feasibility of real-time three-dimensional transoesophageal echocardiography for guidance of percutaneous atrial septal defect closure
Eur J Echocardiogr, June 1, 2009; 10(4): 543 - 548.
[Abstract] [Full Text] [PDF]

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