Role of 3D transesophageal echocardiography in transcatheter closure of atrial septal aneurysms

Abstract

Background Three dimensional transesophageal echocardiography (3DTEE) is superior to two dimensional transesophageal echocardiography (2DTEE) as it provides all atrial septal information from a single view. Aim To evaluate 3DTEE role in analysis of atrial septal aneurysm (ASA) and in device closure guiding. Methods Three dimensional transesophageal echocardiography were recorded with Vivid*E9,GE system over 14 months. ASAs were classified into 4 types (A: with PFO, B: with one ASD, C: with 2 ASDs, and D: with multiple fenestrations). Each aneurysm was assessed according to its type, shape, dimensions, orientation, aneurysmal tissue, and the surrounding rims. All patients passed to transcatheter aneurysm closure. Results A total of 26 patients with ASAs were assessed (7 imperforated aneurysms excluded). The remaining 19 patients’ age was 12.84 ± 5.82years. Four patients had type A aneurysms, 6 had type B, 4 had type C, and 5 had type D. 3DTEE demonstrated oval aneurysms in 17 patients. The orientation was oblique in 8 patients, vertical in 7, and horizontal in 4. The ASAs dimensions were 23.5 ± 5.1, 23.2 ± 5.1, and 22.0 ± 4.0 mm for oblique, vertical, and horizontal axes. Percutaneous closure succeeded in 18 patients. Balloon sizing was used in 4 patients. Devices used were: In type A:PFO devices, in type B:ASO devices, in type C:two patients required two ASO devices in each patient and two patients required one cribriform device, and in type D:Cribriform devices used for three patients, PFO for one and ASO for one. LA, LUPV, and RUPV approaches were used. Aspirin was received for 6 months. Conclusion Three dimensional transesophageal echocardiography helps to select aneurysms suitable for transcatheter closure, select the suitable devices, and guide the transcatheter procedure.

Assessment of Value of Three Dimensional Transesophageal Echocardiography versus Conventional Two Dimensional Transesophageal Echocardiography in Guiding Transcatheter Closure of Atrial Septal Defects and Patent Foramen Ovale

“…RT-3DTEE guidance offers the potential for shorter and safer interventional procedures [ 33 ]. 3DTEE images can be obtained in different modes: biplane, full-volume, live 3D, and 3D zoom imaging, which is the most beneficial because it provides instantaneous images of the entire IAS [ 20 ].…”

“…Then, the image was rotated to the left by 90° in the z-axis. After that, it was tilted to the left around its vertical axis to obtain the view of the IAS from LA perspective [ 20 ].…”

“…Cropping was performed to remove the surrounding structures, image gain was adjusted and, enface view of IAS was obtained [ 20 , 21 ].…”

Atrial Septal Aneurysms – A Clinically Relevant Enigma?

“…Transoesophageal echocardiography is superior to TTE in detecting ASA and also provides better characterisation of ASA morphology, which is crucial in the setting of an Lee et al 2018 [18] associated defect, to assist with optimal closure device selection, and to minimise device related complications [25]. Two dimensional (2D) TOE imaging requires multiple views, may inaccurately estimate the size of an associated atrial septal defect (ASD), as most ASDs are oval in shape, and if used during a closure procedure, requires the interventionalist to mentally reconstruct the complex anatomy of the atrial septum during transcatheter closure [26]. Thus more recently, 3D TOE has been used effectively to guide selection of the occluder device, and facilitate the closure procedure [26].…”

“…Two dimensional (2D) TOE imaging requires multiple views, may inaccurately estimate the size of an associated atrial septal defect (ASD), as most ASDs are oval in shape, and if used during a closure procedure, requires the interventionalist to mentally reconstruct the complex anatomy of the atrial septum during transcatheter closure [26]. Thus more recently, 3D TOE has been used effectively to guide selection of the occluder device, and facilitate the closure procedure [26]. The utility of 3D TOE may be limited in the assessment of an ASA that is highly mobile.…”