Multiplane Transesophageal Imaging During Transcatheter Closure of an Atrial Septal Defect
A 56-year-old woman was admitted with an atrial septal defect of the secundum type. She complained of exertional dyspnea and had slightly elevated systolic pulmonary pressure of 40 mm Hg, as determined by Doppler echocardiography. Transesophageal examination indicated that the interatrial communication was suited for transcatheter closure. The defect measured 1.8 cm in diameter, with a minimal edge width of 5 mm at each side of the defect. Closure was accomplished with the use of a double-umbrella device (ASDOS, Sulzer Osypka) in which two umbrellas are connected by a screw mechanism.1 This device allows repeated attempts to locate the appropriate final position. Overall manipulation of the catheter system could be controlled by fluoroscopy. However, the anatomic structures at the interatrial level and their spatial relationship to the umbrellas could be visualized only with the additional application of multiplane transesophageal echocardiography. Before termination of the intervention, an echo contrast agent was injected via the catheters on both sides of the septum, which confirmed that there was no residual interatrial shunt. After 1 month, the patient was doing well, with normalized pulmonary pressures. Transesophageal echocardiography demonstrated that both sides of the closing umbrellas were covered with a 2- to 4-mm-thick layer of moderately echo-dense material.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
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