Application of transesophageal echocardiography in intraoperative device closure of secundum atrial septal defects

Abstract

To evaluate the clinical value of transesophageal echocardiography (TEE) in guiding intraoperative device closure of secundum atrial septal defect (ASD). Fifty ASD patients, aged 40 +/- 18 (15-72), 34 with an ASD ranging from 30 to 40 mm and 16 with atrial septal aneurysm accompanied by double or more ASDs, underwent intraoperative device closure through a right minithoracotomy without cardiopulmonary bypass and fluoroscopy. Under general anesthesia, a probe was inserted into the esophagus, and TEE was conducted at different planes to observe the characteristics of the ASD. The size of implanted device was determined by TEE. Small parasternal incision was made in the right third or fourth intercostal space. A specially designed plastic sheath loaded with Amplatzer occlusion device was inserted through the purse-string sutures placed on the right atrium. Guided by transesophageal echocardiography, the Amplatzer occlusion device was advanced through the ASD into the left atrium and was deployed in place. The right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV), right ventricular stroke volume (RVSV), right ventricular ejection fraction (RVSV), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular stroke volume (LVSV), and left ventricular ejection fraction (LVEF) before and after the operation were calculated. The procedure was successful conducted in 48 patients. And the other two patients failing to receive this procedure, one having a large ASD that could not be occluded and the other with ASD accompanied by partial anomalous pulmonary venous connection, were shifted to operation with cardiopulmonary bypass. After the operation, the RVEDV was (94 +/- 32) ml, and the RVSV was (52 +/- 20) ml respectively, both significantly lower than those before the operation [(78 +/- 23) ml and (41 +/- 13) ml respectively, both P < 0.05]. The LVEDV and LVSV after operation were (73 +/- 19) ml and (50 +/- 11) ml respectively, both significantly higher than those before operation [(56 +/- 14) ml and (34 +/- 12) ml respectively, both P < 0.05]. TEE provides valuable information in further confirmation of diagnosis of ASD, selection of appropriate size of Amplatzer occluder, guidance of the deployment of occluder, observation of the effects of operation, and prompt detection of complication.