Published Online
on January 13, 2003

A more recent version of this article appeared on February 11, 2003

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Submitted on August 21, 2002
Revised on October 24, 2002
Accepted on October 28, 2002

Beating Atrial Septal Defect Closure Monitored by Epicardial Real-Time Three-Dimensional Echocardiography Without Cardiopulmonary Bypass

Yoshihiro Suematsu MD^*, Shinichi Takamoto MD, Yukihiro Kaneko MD, Toshiya Ohtsuka MD, Hiroo Takayama MD, Yutaka Kotsuka MD, and Arata Murakami MD

From the Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan.

^* To whom correspondence should be addressed. E-mail: suematsu-THO{at}h.u-tokyo.ac.jp.

Background--We assessed the feasibility of beating atrial septal defect (ASD) closure monitored by real-time 3D echocardiography (RT3DE).

Methods and Results--RT3DE was developed with prototype ultrasound equipment consisting of a high-speed 3D rendering unit with a frame rate of 5 to 10 frames/s. We also developed a prototype semiautomatic suture device and suture cutting system. In the experiment, 12 mongrel dogs were anesthetized, and after median sternotomy, the echo probe was applied directly to the surface of the right atrium. Three surgical maneuvers (balloon atrial septectomy, enlargement of the ASD, and ASD closure) were performed through the atrial port inserted into the right atrial appendage. The heart was then excised, and the area of the ASD measured by RT3DE was compared with its area measured directly. The ASD was successfully closed in all experimental animals except the first 2. Examination of the excised heart showed that none of the sutures were loose. The mean area of the ASD was 82.5±38.6 mm² when measured by RT3DE and 81.6±38.2 mm² when measured directly, and there was a significant correlation between the areas measured by RT3DE and those measured directly (echo measurements=1.007xdirect measurements+0.337; P<0.0001). A Bland-Altman analysis revealed close agreement between the results obtained by the 2 methods (7.807 mm² upper and -6.024 mm² lower limit of agreement).

Conclusions--Introduction of RT3DE, a semiautomatic suture device, and a suture cutting system made beating ASD closure without cardiopulmonary bypass possible.

Key words: cardiopulmonary bypass • echocardiography • heart septal defects

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