Abstract 1873: Initial Experience with Real-Time Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Transcatheter Atrial Septal Defect Closure
Background: Transcatheter closure of atrial septal defects (ASD) is performed with intracardiac or transesophageal echocardiography (TEE) guidance. ASDs often have an elliptical shape and 2D imaging may underestimate the maximum diameter. Three-dimensional (3D) TEE using reconstructed gated acquisitions in multiple planes is a time-consuming process limited by motion artifact, making it impractical for intra-procedural use. Recently, a matrix array TEE capable of real-time 3D (RT3D) imaging has been developed (Philips Medical Systems).
Methods: Two-dimensional, Doppler and RT3D TEE images were acquired in 5 patients undergoing ASD closure. Device selection was based on the maximum diameter of the ASD measured by 2D imaging. RT3D images were analyzed using commercially available software (QLab, Philips). The maximum diameter was measured and compared to 2D.
Results: The mean maximum diameter was 1.6 ± 0.8 cm using 2D imaging and 2.0 ± 1.1 cm using RT3D images (p=0.16). In the 3 patients with ASDs >2 cm, the maximum diameter was 2.2 ± 0.1 cm by 2D imaging compared to 2.8 ± 0.3 cm by RT3D imaging (p=0.02), an underestimate of 20.7 ± 12.2 %. In the remaining 2 patients with ASDs <1.2 cm, there was good agreement between 2D and 3D measurements. In the 2 patients with the largest discrepancy between 2D and 3D measurements, the initial device selected was retrieved prior to catheter release, due to significant residual shunting or instability along the septum, requiring placement of a larger device.
Conclusion: RT3D TEE during transcatheter ASD closure is feasible and may improve defect sizing and device selection during transcatheter ASD closure.