Abstract 12470: Defining Patent Foramen Ovale Anatomy and Morphological Phenotypes Using Three-Dimensional Transoesophageal Echocardiography: A Practical Approach
Background Three dimensional transoesophageal echocardiography (3D TEE) has allowed better understanding of atrial septal anatomy and patent foramen ovale (PFO) morphology. Anatomical variations seen in patients undergoing transcatheter device closure may influence device choice and procedural success. A practical approach to define and quantify salient features of more complex anatomical characteristics, by 3D echocardiography, has been suggested. How frequently these features occur is not known.
Methods PFO morphology was assessed using full 3D TEE datasets available for 37 patients, with otherwise structurally normal hearts, undergoing transcatheter PFO closure at our institution from July 2009 to January 2011. Datasets obtained using a Philips iE33 ultrasound system were analysed either on or offline (QLab 3DQ, Philips Healthcare). PFO's were grouped into simple or complex according to anatomical characteristics. Complex defects were defined as: long tunnel length >8mm, multiple openings into the left atrium, atrial septal aneurysm (septal sway >10mm), hybrid defect (additional small defect(s) in fossa ovalis), thick secundum septum (>8mm), Eustachian ridge (ER), Eustachian valve or Chiari network.
Results 92% of patients (n=34) had features of a complex PFO.76% of patients had a ER (n=28). 20 patients had a Eustachian valve and or a Chiari network. Median tunnel length was 5mm (<1-20mm), 24 % of patients (n=9) had a tunnel length >8mm. 11% (n=4) patients had an atrial septal aneurysm, median septal sway 5mm (1-12mm). 19% (n=7) of PFO's were hybrid defects and 4 patients had more that one opening into the left atrium. 2 of the patients had a significantly thickened secundum septum >8mm, median thickness was 4.9mm (0-8.9mm). Follow up bubble study data was available for 19 of the 37 patients (at 6-12 months), 2 patients had residual shunts. There was no association with any particular anatomic feature.
Conclusion 3D echo allows a practical qualitative and quantitative assessment of PFO anatomy and morphology. A detailed understanding of the complex variation in anatomy is crucial to guide device selection and to achieve successful percutaneous closure.
- © 2011 by American Heart Association, Inc.