Abstract
BackgroundProper device size selection is a crucial step for successful ASD device closure. The current gold standard for device size selection is balloon sizing. Balloon sizing can be tedious, time consuming and increase fluoroscopy and procedure times as well as risk of complications. We aimed to establish a simple and accurate method for device size selection using three-dimensional echocardiographic interrogation of the ASD.This is a prospective observational study conducted over a period of 12 months. All patients underwent 2D TTE, three-dimensional echocardiographic assessment of the IAS and transesophageal echocardiogram. Comparison between echocardiographic variables was done using independent sample t test. Linear correlation was established between three dimensional echocardiographic variables and respective variables of device size and 2D TTE and TEE measurements.ResultsThe study included 50 patients who underwent successful ASD device closure with properly sized device. There was no significant difference between 3D ASD maximum diameter and all diameters measured by TTE and TEE. There was a strong positive correlation between device size used for closure and both 3D measured ASD area (r = 0.907, P<0.0001) and 3D measured ASD circumference (r = 0.917, P<0.0001). Two regression equations were generated to determine proper device size where Device size = 10.8 + [3.95 x 3D ASD area] and Device size = [3.85 x 3D ASD circumference] -1.02ConclusionThree-dimensional echocardiogram can provide a simple and accurate method for device size selection in patients undergoing ASD device closure using either 3D derived ASD area or ASD circumference
Highlights
Proper device size selection is a crucial step for successful atrial septal defect (ASD) device closure
Patients with any of the following criteria were excluded from the study: (1) Primum ASD (2) Eisenmenger syndrome (3) associated congenital anomalies requiring surgical intervention (4) Secundum ASD with unsuitable anatomy for closure due to defective or floppy rims diagnosed by transthoracic or transoesophogeal echocardiography (5) Secundum ASD larger than 36 mm in diameter (6) Patients with inter atrial septal aneurysm or fenestrated septum with multiple defects for which Three dimensional (3D) tracing of the defect to produce 3D derived area and circumference deemed impossible or inaccurate
Proper device size selection was defined as absence of significant residual shunt around free edge of device, no encroachment to surrounding structures with proper reshaping in correct profile
Summary
Proper device size selection is a crucial step for successful ASD device closure. The current gold standard for device size selection is balloon sizing. We aimed to establish a simple and accurate method for device size selection using three-dimensional echocardiographic interrogation of the ASD.This is a prospective observational study conducted over a period of 12 months. Linear correlation was established between three dimensional echocardiographic variables and respective variables of device size and 2D TTE and TEE measurements. Using balloon sizing to determine the device size for trans-catheter ASD closure has been regarded as the gold standard. Several studies have been conducted to avoid balloon sizing during the Assessment of ASD morphology and relationship with near-field structures was enhanced through the introduction of three-dimensional echocardiography [3]. 3D-TEE plays a Roushdy et al The Egyptian Heart Journal (2020) 72:1 crucial role in 3D real-time guidance of percutaneous closure [5]
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