Real-time Three-dimensional Transoesophageal Echocardiography for Guidance of Transcatheter Closure of a Complex Multifenestrated Atrial Septal Defect

Abstract

R 2 ∗ f E p rial septumwith a 20mm secundum anterosuperior ASD Fig. 2, asterisk) adjacent to the aortic root and seven maller discrete fenestrations of varying size in the adjaent posteroinferior septum (Fig. 2, arrow), displayed on a ingle viewonTOEusing the “3Dzoom” function (Phillips E33, PhillipsHealthcare, Andover,MA,USA). Therewere ultiple jets of continuous left-to-right shunting (Fig. 3, rrows, online video 1) and a deficient aortic rim assoiated with the large anterosuperior defect. Despite the ultifenestrated appearance and deficient aortic rim, the atient strongly wished to avoid surgery, therefore trancatheter closure was performed. Whilst these two factors ncrease the technical difficulty of successful transcatheter losure, they are not absolute contraindications [1]. Utilising TOE and fluoroscopic guidance, a sizing alloon measured the stretched anterosuperior ASD iameter at 28mm.A single device strategywas employed 28mm Amplatzer, AGA Medical, Minnesota, USA), iming to occlude the main anterosuperior defect and Figure 1. 2D Transoesophageal Echocardiogram mid-oesophageal 4-chamber view showing right ventricular enlargement.