Assessment Of Atrial Septal Defects Research Articles

Assessment of Atrial Septal Defects through Advanced Three-Dimensional Transesophageal Echocardiography Imaging

This article presents a study on the use of three-dimensional transesophageal echocardiography (3D TEE) in the evaluation of atrial septal defects (ASD) in adults. With 3D TEE, a more accurate anatomical assessment of the atrial septum is achieved, allowing precise measurement of size, shape, and border characteristics of the ASD. In a series of 27 cases, the 3D evaluation showed a strong correlation between measured parameters and the size of the closure device required. 3D TEE appears to be a significant advancement in cardiovascular imaging, enhancing pre-interventional assessment and the success of interventions for ostium secundum ASD.

Contribution of Three-Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Defects (ASD)

The article examines the contribution of real-time three-dimensional transesophageal echocardiography (3D TEE) in the assessment of ostium secundum atrial septal defects (ASD) in adults. 3D TEE provides a precise and comprehensive view of cardiac anatomy, enabling the evaluation of size, shape, and border quality of the ASD. In a series of 27 cases, 3D TEE demonstrated a strong correlation between 3D-measured ASD parameters and the size of the closure device required. This technique is crucial for accurate pre-interventional evaluation, enhancing the success and safety of percutaneous or surgical interventions for ostium secundum ASD. Three-dimensional transesophageal echocardiography represents a significant advancement in cardiovascular imaging for complex structural heart abnormalities.

Perioperative Echocardiographic Assessment of Atrial Septal Defect: Key Learning Points for Fellows/Residents in Training

Perioperative Echocardiographic Assessment of Atrial Septal Defect: Key Learning Points for Fellows/Residents in Training

Assessment of atrial septal defects using 3-dimensional transthoracic echocardiography prior to percutaneous device closure: first report from Bangladesh.

Secundum atrial septal defect (ASD) is treated following trans-catheter closure in alternative to surgical treatment. Per-intervention selection of device size with balloon occlusive diameter (BOD) often cause tearing or enlarging, causing arrhythmias and hypotension. We assessed the suitability of percutaneous device closure for ASD using 3-dimensional transthoracic echocardiography (3DTTE). This study was conducted to investigate if 3DTTE could be an alternative of balloon sizing for selection of device size in atrial septal defect device closure. It was a cross-sectional comparative study. This study was conducted at the department of Pediatric Cardiology, Bangabandhu Sheikh Mujib Medical University for a period of 2 years. Thirty-three purposively selected secundum ASD patients suitable for device closure were included in the study. Ethical permission was taken from the Institutional Review Board and written consent was taken from each patient's guardian. In this study, 3DTTE derived ASD diameter and BOD were compared with that of deployed device size using correlation analysis. Out of 33 patients, 63.6% were female and 36.4% were males had a mean age of 18.07 ± 14.58 years (range 2-55 years). Mean diameter of ASD measured by 2-dimensional (2D) and 3-dimensional (3D) echocardiography were 17.09 ± 6.08 mm and 21.30 ± 6.56 mm, respectively, yielding a significant difference (p < 0.001). 3D echocardiography derived ASDs diameter were highly correlated with device size than BOD and 2D echocardiography derived diameter (2D echocardiography: r = 0.796, p = <0.001, 3D echocardiography: r = 0.960, p = <0.001, BOD: r = 0.840, p = <0.001). 3DTTE can accurately measure ASD diameter and can be used as an alternate, effective, and safe method to select device size.

Assessment of Transcatheter or Surgical Closure of Atrial Septal Defect using Interpretable Deep Keypoint Stadiometry.

Automated echocardiogram interpretation with artificial intelligence (AI) has the potential to facilitate the serial diagnosis of heart defects by primary clinician. However, the fully automated and interpretable analysis pipeline for suggesting a treatment plan is largely underexplored. The present study targets to build an automatic and interpretable assistant for the transthoracic echocardiogram- (TTE-) based assessment of atrial septal defect (ASD) with deep learning (DL). We developed a novel deep keypoint stadiometry (DKS) model, which learns to precisely localize the keypoints, i.e., the endpoints of defects and followed by the absolute distance measurement with the scale. The closure plan and the size of the ASD occluder for transcatheter closure are derived based on the explicit clinical decision rules. A total of 3,474 2D and Doppler TTE from 579 patients were retrospectively collected from two clinical groups. The accuracy of closure classification using DKS (0.9425 ± 0.0052) outperforms the "black-box" model (0.7646 ± 0.0068; p < 0.0001) for within-center evaluation. The results in cross-center cases or using the quadratic weighted kappa as an evaluation metric are consistent. The fine-grained keypoint label provides more explicit supervision for network training. While DKS can be fully automated, clinicians can intervene and edit at different steps of the process as well. Our deep learning keypoint localization can provide an automatic and transparent way for assessing size-sensitive congenital heart defects, which has huge potential value for application in primary medical institutions in China. Also, more size-sensitive treatment planning tasks may be explored in the future.

Role of Echocardiography in the Transcatheter Closure of Atrial Septal Defect

Transcatheter closure of secundum atrial septal defect (ASD) is one of the most common structural cardiac interventions. Imaging the defect is the cornerstone of the procedure at different stages of the intervention. The imaging modalities most commonly used are transthoracic and transesophageal echocardiography (TTE and TEE, respectively). Less commonly used are intracardiac echocardiogram and fusion navigation techniques. From the planning stage, a detailed anatomic and hemodynamic assessment of ASD is required for deciding suitability of device closure. Intraprocedural imaging guidance again is essential for a successful device deployment. Various assisted techniques like balloon assistance also require live TEE guidance. Confirming an acceptable device deployment is imaging dependent. Long-term follow-up of the patient for different parameters is done with the help of echocardiographic screening. A detailed understanding of echocardiographic imaging at different stages of the ASD device closure is the key for success.

Assessment of atrial septal defect using 2D or real-time 3D transesophageal echocardiography and outcomes following transcatheter closure.

BackgroundThe assessment of interatrial septum (IAS) requires a standardized, systematic approach, including two-dimensional transthoracic echocardiography (2D TTE), 2D transesophageal echocardiography (2D TEE), and three-dimensional (3D) TEE. Although 2D TEE has been widely used for the preoperative assessment of atrial septal defect (ASD), its ability to provide reliable information is often limited due to the structural characteristics of IAS. The introduction of 3D TEE provides a unique “en face” view of IAS, which allows the visualization and accurate measurements of diameters, area, and rims of ASD. Hence, appropriate ASD imaging information is particularly important in successful transcatheter closure.MethodsIn this retrospective study, 2D TTE/TEE, and 3D TEE were performed before ASD closure, with 2D minimal and maximal diameters, areas, and residual rims being recorded. Adequate 3D TEE imaging data sets were collected and then analyzed. ASD related parameters were compared using different echocardiography. Patients who underwent ASD closure completed a clinical follow-up.ResultsThe mean defect maximal diameter and aperture area by 3D TEE was significantly larger than that of the corresponding 2D TEE (P<0.05). There was no statistical difference in the minimal and maximal diameter or area by TEE for circular-shaped ASDs. For oval ASDs, mean minimal diameter on 2D TEE was larger than that on 3D TEE. The mean maximal diameter measured using 2D TEE was smaller than the 3D TEE measurement (16.0±7.1 vs. 19.8±8.6; P<0.05). For complex-shaped defects, there were statistical differences in minimal and maximal diameter between TEEs. Furthermore, 2D and 3D TEE had a longer superior vena cava (SVC) residual rim than did 2D TTE (P<0.05). The 3D TEE residual rims of the inferior vena cava (IVC) was significantly larger than the corresponding 2D TEE. There was a very strong correlation between the residual rim measurements using 3D and 2D TEE. However, the limits of agreement between 2D and real-time 3D TEE measurements were more apparent in the IVC rim group than in the other groups.ConclusionsOur study confirms the value of 3D TEE in assessing ASD shape and size reported by previous studies, and is also the first to accurately and systematically characterize ASD residual rim in complex ASDs.

Reliability of Transthoracic Echocardiography to Guide Transcatheter Closure of Atrial Septal Defects

Introduction: Transthoracic echocardiography (TTE) is used for the pre-interventional assessment of atrial septal defects (ASDs). However, the efficacy of TTE for guiding transcatheter closure of ASD still has not been widely assessed. The aim of this study was to evaluate the efficacy, and reliability of TTE in pre selecting ASDs for transcatheter closure using the Occlutech Figulla ASD occluder. Patients & methods: This was a prospective study carried out between April 1, 2019 and February 1, 2020. Forty-nine patients were referred for transcatheter closure of their ASDs at mean age of 22±18 years and mean weight of 36±17 kg. TTE was used to measure the largest ASD diameter in different views. The device diameter used for closure was chosen based on the largest diameter obtained by TTE plus 3-5 mm if ASD < 20 mm, and 5-6 mm if ASD > 20 mm. Results: The patients divided into two groups according to the size of ASD, group A when the size of the defect was < 20 mm, and group B when the size of the defect was > 20 mm. The average size of the defects for group A 16±4 mm, and 28±6mm for group B. the average size of the devices used was 19±5mm, and 33±7 mm for group A and B respectively. Transcatheter closure of ASD was successful in 41 patients (83.6%), and failed in 8 patients (16.4%). In 7 out of the 8 failed cases, the closure was achieved successfully using transesophageal echocardiography (TEE) guidance and one patient, was referred for surgical closure due to an acute complication due to large pericardial effusion and tamponade that resulted from injury to the left atrial appendage. The successful rate for selection of the appropriate ASD device was 83.6%. Conclusion: this study demonstrated that TTE is satisfactory & reliable in selecting the appropriate ASD device size & in guiding transcatheter closure of ASD.

Transcatheter Closure of Atrial Septal Defects with Cardiac Computed Tomography Sizing: Eight-Year Single-Center Practice

Introduction: An accurate evaluation of atrial septal defect (ASD) is important for the success of interventional treatment. Cardiac computed tomography (CT) has unique advantages for ASD assessment, although transesophageal echocardiography (TEE) remains the accepted method. Objective: This study aimed to evaluate the safety and feasibility of transcatheter closure of ASD with cardiac CT sizing but without TEE measurement. Methods: Among 134 patients undergoing transcatheter closure, 13 underwent TEE in addition to a cardiac CT examination, and 121 underwent only cardiac CT. Propensity score matching was used to analyze the outcomes of the groups treated with (group 1) or without (group 2) TEE examinations. The success rate and complications among the 121 ASD patients with only cardiac CT sizing were recorded and analyzed. The maximal diameters of the defects remeasured on CT images were compared to the echocardiography results and correlated with the device size by Student t test and Pearson’s linear regression analysis, respectively. Results: No significant differences (p > 0.05) were found between groups 1 and 2 in the success rate, complications, or ratio of the device size to the maximum diameter of the defect measured by cardiac CT. In group 1, the maximum diameters of the ASD derived from cardiac CT and TEE were comparable (22.08 ± 9.68 vs. 21.50 ± 10.24; p = 0.351). The success rate among the 121 patients who underwent transcatheter closure with only cardiac CT sizing was 99.2%; however, within 1 month of follow-up, 2 patients had arrhythmia, 1 patient had residual shunting, 1 patient had an infection, and 1 patient had a hematoma, but all patients recovered within a short time. Conclusions: Cardiac CT seems to be comparable to TEE in the assessment of ASD, and transcatheter closure of ASD based on CT sizing alone is safe and feasible.

Echocardiographic Evaluation of Atrial Septal Defect

Atrial septal defect accounts for 8-10% of all congenital heart defects. Echocardiography is method of choice for assessment of patient with a known or suspected atrial septal defect. A Thorough knowledge and understanding of all echocardiographic view is essential for complete assessment of atrial septal defect, associated physiological status and assessment of neighbouring intracardiac structures. Complete evaluation is crucial for planning the modality of treatment whether it is suitable for catheter intervention or needs surgical intervention.

Hemodynamic assessment of atrial septal defects.

Atrial septal defect (ASD) is one of the most common congenital cardiac anomalies. ASD can present as an isolated lesion in an otherwise normal heart or in association with other congenital heart conditions. Regardless of the type of ASD, the direction and degree of shunting across the communication is mainly determined by the difference in compliance between the right and left ventricle. Hemodynamics in children is characterized by left-to-right shunting, dilated right heart structures and normal pulmonary artery pressures (PAP). Patients diagnosed at adult age often present with complications related to long-standing volume overload such as pulmonary artery hypertension and right and left ventricular dysfunction. Diagnostic catheterization is usually not indicated unless there is suggestion of pulmonary hypertension on echocardiography. In older patients and/or in those with ventricular dysfunction, measurement of left heart pressures during temporary balloon occlusion is recommended prior to device closure as it may not be tolerated. In ASD associated with other congenital malformations, shunting degree and direction will depend upon underlying condition. Restrictive ASD can result in significant hemodynamic compromise in neonates with conditions such as hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA). In most cases, hemodynamics can be estimated with echocardiography only.

The role of three-dimensional transesophageal echocardiography in preoperative assessment of atrial septal defects

An atrial septal defect is the most common congenital heart disease. Transcatheter defect closure has become widespread in recent times and the requirements for this procedure are rather strict. Two-dimensional echocardiography is limited in evaluating atrial septal defects because it provides planar images only. In order to preoperatively assess atrial septal defects, we applied three-dimensional transesophageal echocardiography and then compared the results with those of surgical operations. The maximum diameter, shape, area and localization of the atrial septal defect in 26 patients were estimated with three-dimensional echocardiography. It was found out that positive correlation existed between three-dimensional echocardiography findings and those measured during surgery. Three-dimensional echocardiography provides invaluable assistance in preoperative evaluation of atrial septal defects and in selection of treatment.

Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions.

Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions.

Three-dimensional transesophageal echocardiography and cardiac magnetic resonance imaging as complementary modalities in diagnosis and assessment of atrial septal defect: a case presentation.

Three-dimensional transesophageal echocardiography and cardiac magnetic resonance imaging as complementary modalities in diagnosis and assessment of atrial septal defect: a case presentation.

OP-183 Experience with Three-Dimensional Transesophageal Echocardiography During Percutaneous Closure of Atrial Septal Defects

Accurate assessment of atrial septal defect (ASD) size, length and relationship of the ASD to surrounding cardiac structures is essential for successful closure of ASD. Appropriate device selection is also dependent to the exact measure of the ASD. Guidance for device closure of ASD with three-dimensional transesophageal echocardiography (3DTEE) is the method of choice in experienced centers which provides size, shape, orientation, numbers of orifices and rim status in one single en face view. In our study, we aimed to compare the defect sizes measured with two-dimensional transesophageal echocardiography(2DTEE) and 3DTEE in patients who had secundum ASD.

Three-dimensional echocardiographic assessment of atrial septal defects.

Echocardiography provides a useful tool in the diagnosis of many congenital heart diseases, including atrial septal defects, and aids in further delineating treatment options. Although two-dimensional echocardiography has been the standard of care in this regard, technological advancements have made three-dimensional echocardiography possible, and the images obtained in this new imaging modality are able to accurately portray the morphology, location, dimensions, and dynamic changes of defects and many other heart structures during the cardiac cycle.

A Case of Transcatheter Closure of an Atrial Septal Defect Guided by Three Dimensional Echocardiography

Abstract Real time three dimensional transthoracic echocardiography (RT3DE) is rapidly emerging as the imaging modality of choice for assessment of atrial septal defects. This novel imaging modality provides incremental information about the morphology of atrial septal defects (ASD), allowing precise characterization of septal defects. Our case highlights the limitations of conventional echo imaging and the advantages of RT3DE in planning percutaneous ASD closure.

Echocardiographic Assessment of Atrial Septal Defects

Echocardiographic Assessment of Atrial Septal Defects

Real-Time Three-Dimensional Transesophageal Echocardiography in Patients with Secundum Atrial Septal Defects: Outcomes following Transcatheter Closure

Successful transcatheter closure of atrial septal defects (ASDs) requires the accurate assessment of defect size and morphology. Assessment of ASD anatomy may be difficult by two-dimensional (2D) echocardiography. The aim of this study was to test the hypothesis that real-time three-dimensional (3D) transesophageal echocardiography (TEE) may provide more accurate morphologic assessment of ASDs than multiplane 2D TEE. Twenty-four patients with ASDs were imaged using 2D and real-time 3D TEE. ASD shape and size were assessed using 3D TEE retrospectively. Maximal ASD dimensions obtained by 3D TEE were compared with unstretched and balloon-stretched dimensions on 2D TEE. Planimetered defect area by 3D TEE was compared with area calculated using the ellipse formula from 2D imaging. Twenty of the 24 patients underwent transcatheter ASD closure. Closure device size was based on findings on 2D TEE. Follow-up was conducted by 2D transthoracic echocardiography. Of the 24 ASDs, 6 (25%) were circular, 10 (42%) were oval, and 8 (33%) were complex in shape. The mean maximal dimension was larger by 3D TEE compared with 2D TEE (1.8 ± 0.8 vs 1.5 ± 0.6 cm; P < .05). There was no difference in the mean area measured by either modality, but for complex-shaped defects, area measured by 3D TEE was larger than that by 2D TEE (2.8 ± 1.3 vs 1.7 ± 1.4 cm(2); P < .05). Follow-up transthoracic echocardiography was available for 19 of the 20 patients undergoing transcatheter closure. Nine patients had residual right-to-left shunting 1 to 6 months after ASD closure, and the majority of these were complex in shape. In patients with residual shunting, ASD area by 3D TEE was 27% larger than by 2D TEE, whereas in patients without residual shunting, there was significantly less discrepancy between 3D and 2D areas (19%; P= .0027). Three-dimensional TEE can identify ASD shape. Maximal dimensions on 3D TEE were well correlated with balloon-stretched 2D dimensions. Two-dimensional TEE can underestimate the area of complex-shaped ASDs, which may result in residual right-to-left shunting.

Pre-procedural planning for percutaneous atrial septal defect closure: Transesophageal echocardiography compared with cardiac computed tomographic angiography

The safety and efficacy of percutaneous closure of atrial septal defects (ASDs) is determined by several variables, including defect size, presence of adequate rim tissue, relationship to other cardiac structures, and associated congenital anomalies. We sought to determine the accuracy of computed tomographic angiography (CTA) in predicting a defect's size compared with pre-procedural transesophageal echocardiography (TEE) and to the current "gold standard" balloon sizing by intracardiac echocardiography (ICE). Thirty-five consecutive patients referred for possible percutaneous closure of suspected secundum ASD were evaluated with gated multislice CTA after initial TEE screening. Axial and sagittal image planes of the ASD from the CTA multiplanar reformation (MPR) images were used to measure the defect size and surface area. Of the 35 patients with secundum-type ASDs, 5 subjects had disqualifying anatomy by CTA and 2 had an unsuccessful closure, resulting in a procedural success rate of 93%. Measurement of defect area by gated MPR images provided the strongest correlate to ICE balloon size. In large ASDs, TEE was less well correlated to the maximum defect size and identification of the inferior/inferoposterior rims than CTA. Cardiac CTA is an accurate and useful technique for pre-procedural assessment of ASDs and may be superior to conventional TEE in large defects that have deficient inferior rims.