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Catheter-Based Atrial Septal Defect Closure

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Intraprocedural Imaging of Cardiovascular Interventions

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Abstract

Atrial septal defects (ASDs) are among the most common congenital heart defects in adults. Ostium secundum type ASDs account for 70 % of all defects and the majority are amenable to percutaneous closure. At present, non-secundum ASDs require surgical repair. Echocardiography has emerged as an essential imaging tool to characterize defect anatomy, measure ASD dimensions, identify candidates for percutaneous closure, and facilitate appropriate device selection. Intra-procedural echocardiographic guidance is critical to transcatheter closure. 3D transesophageal echocardiography offers significant advantages over 2-dimensional imaging by providing highly accurate representations of septal defects in the en face views.

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Author information

Authors and Affiliations

  1. Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, NY, 10106, USA

    Nathaniel R. Smilowitz & Muhamed Saric MD, PhD

Authors
  1. Nathaniel R. Smilowitz
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  2. Muhamed Saric MD, PhD
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Corresponding author

Correspondence to Muhamed Saric MD, PhD .

Editor information

Editors and Affiliations

  1. Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

    Michael H. Picard

  2. Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

    Jonathan J. Passeri

  3. Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

    Jacob P. Dal-Bianco

Electronic Supplementary Material

Video 5.1

2D TEE in midesophageal four-chamber view at 0°, demonstrates the posterosuperior rim (υ) and the atrioventricular rim (ϖ) of a secundum ASD (asterisk). LA left atrium, RA right atrium, RV right ventricle (MP4 1705 kb)

Video 5.2

2D TEE in midesophageal short-axis view at 60°, demonstrates the posteroinferior rim (ω) and the anterior or aortic rim (ξ) of a secundum ASD (asterisk). A highly mobile linear echo density in the RA consistent with Chiari network is also seen. LA left atrium, RA right atrium, RVOT right ventricular outflow tract (MP4 1925 kb)

Video 5.3

2D TEE in the bicaval view at 120°, demonstrates the inferior vena cava rim (ψ) and the superior vena cava rim (ζ) of a secundum ASD (asterisk). A highly mobile linear echo density in the RA consistent with Chiari network is also seen. LA left atrium, RA right atrium, SVC superior vena cava (MP4 2106 kb)

Video 5.4

Zoomed 3D TEE imaging demonstrates the so-called TUPLE (tilt-up then left) maneuver for visualizing a secundum ASD in an anatomically correct manner. The clip first reveals the en face view of the secundum ASD from the RA perspective and then from the LA perspective. ASD atrial septal defect, AV aortic valve, IVC inferior vena cava, SVC superior vena cava (MP4 839 kb)

Video 5.5

2D TEE in the apical three-chamber (LVOT) view demonstrates an Amplatzer ASD occluded (arrow) which after embolization into the left ventricle protrudes into the LVOT during systole. AV aortic valve, LA left atrium, LV left ventricle, RVOT right ventricular outflow tract (MP4 2889 kb)

Video 5.6

2D TEE in midesophageal view at 70°, demonstrates a residual leak (arrow) around a Gore Helex ASD occluder. LA left atrium, RA right atrium (MP4 585 kb)

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Smilowitz, N.R., Saric, M. (2016). Catheter-Based Atrial Septal Defect Closure. In: Picard, M., Passeri, J., Dal-Bianco, J. (eds) Intraprocedural Imaging of Cardiovascular Interventions. Springer, Cham. https://doi.org/10.1007/978-3-319-29428-5_5

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  • DOI: https://doi.org/10.1007/978-3-319-29428-5_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29426-1

  • Online ISBN: 978-3-319-29428-5

  • eBook Packages: MedicineMedicine (R0)

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