Author + information
- Tiina Ojala, MD, PhD,
- Eric Rosenthal, MD,
- Kelly Nugent, BSc,
- Shakeel Qureshi, MD and
- John Simpson, MD⁎ ()
- ↵⁎Address for correspondence:
John M. Simpson, Evelina Children's Hospital, London SE1 7EH, United Kingdom
percutaneous closure has become the treatment of choice for most secundum atrial septal defects (ASD). Transesophageal or XTYUGHN intracardiac 2-dimensional echocardiography are well-established guidance techniques for initial septal device placement. Small residual defects often close spontaneously, but in a small minority of patients a defect persists. Closure of residual ASDs following placement of a septal occluder device can be technically challenging. Three-dimensional (3D) echocardiography produces en-face images of the atrial septum that cannot be obtained using cross-sectional techniques (Online Video 1) (1).
3D echocardiography has advantages over 2-dimensional echocardiography in the assessment of the mechanisms responsible for residual shunts as well as the shape of any residual defect, which is critical to allow complete closure. It allows imaging of the delivery system(s) during additional device placement. The 3D approach to planning and guidance of septal occlusion using 3D echo is illustrated in Online Video 2. A crescentic shaped residual ASD is illustrated from the right atrial aspect in Figure 1 (Online Video 3). Delivery catheters and occlusion devices are visualized from the left atrial aspect (Fig. 2, Online Videos 4, 5, 6, and 7) and the localization of a residual leak following placement of multiple devices is facilitated by the use of saline contrast echocardiography (Fig. 3, Online Video 8). More than 2 devices may be necessary to close the ASD and 3D echocardiography assists in determining delivery system position and configuration of multiple devices to each other (Fig. 4, Online Videos 9 and 10).
For supplementary videos, please see the online version of this article.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation