Absent posteroinferior and anterosuperior atrial septal defect rims: Factors affecting nonsurgical closure of large secundum defects using the Amplatzer occluder.
ABSTRACT Using transesophageal echocardiography, we sought to determine the anatomic characteristics of the secundum atrial septal defects (ASDs) that extend into the inferior sinus venosus and have no posteroinferior (PI) rim, to determine the factors related to potential closure with an Amplatzer occluder. We also sought to understand why large secundum ASDs with a PI but without an anterosuperior (AS) rim may require special techniques to reorient the left atrial disk before deployment of the waist and right atrial disk. We measured the lengths of 5 separate rims of the circumferences of 76 secundum ASDs, including anteroinferior, AS, superior, posterosuperior, and PI rims. We also measured anteroposterior and superoinferior defect diameters, total septal lengths, and the ratios of defect diameter to total septal length. The atrial depth was measured at the axial angle of the delivery sheath in 5 defects with no AS rim for which special techniques were required to achieve successful closure. Of 76 secundum ASDs, 13 (17%) had no PI rim. Each defect extended from the fossa ovalis into the inferior sinus venosus. Compared with defects with a PI rim, the factors related to potential closure included 100% larger defect diameters, shorter posterosuperior rim lengths, larger defect to total septal length ratios, and completely flat posterior atrial walls. When the AS rim was absent the factors related to the need for special techniques included diameters >/= 22 mm, atrial depth < the calculated Amplatzer occluder left atrial disk diameter, rigid wire/disk interface, and obligatory left atrial disk orientation more or less perpendicular to the atrial septal plane.
04/2012; , ISBN: 978-953-51-0531-2
Article: [Correction of the perpendicular positioning of the Amplatzer device during closure of an ostium secundum atrial septal defect].[show abstract] [hide abstract]
ABSTRACT: Ostium secundum atrial septal defects require closure. Echocardiographic studies have reported that, in 7% of cases, the Amplatzer occluder is orientated perpendicular to the rim of the defect. This article describes the use of an ancillary technique involving a balloon catheter that enables the Amplatzer device to be positioned transversely. We report six patients with an ostium secundum atrial septal defect in whom echocardiographic imaging showed that the Amplatzer device was positioned perpendicular to the rim of the defect. To correct the device's orientation, we used an ancillary maneuver that involved placing a balloon catheter at the device's lower edge, thereby inducing it to adopt a transverse position and undergo successful implantation. In all cases, the ancillary balloon catheter technique enabled the device to adopt the correct transverse orientation, thereby facilitating successful implantation. The ancillary balloon catheter technique is useful for ensuring that Amplatzer devices adopt a transverse orientation when echocardiography shows the device to be persistently orientated perpendicular to the rim of the septal defect.Revista Espa de Cardiologia 08/2008; 61(7):714-8. · 2.53 Impact Factor
Article: Single-plane balloon sizing of atrial septal defects with intracardiac echocardiography: an advantageous alternative to fluoroscopy.[show abstract] [hide abstract]
ABSTRACT: We sought to evaluate intracardiac echocardiography (ICE) in comparison with transesophageal echocardiography and fluoroscopy for sizing of atrial septal defects (ASDs). In 43 patients (mean age 40 +/- 15 years) with ASD, the native defect size was measured by transesophageal echocardiography and ICE. On subsequent balloon sizing, the stretched balloon diameter was measured by both fluoroscopy in two perpendicular planes and by ICE in just a single standard cut plane. All ASDs were successfully closed with Amplatzer occluders (AGA Medical Corp., Plymouth, Minn). Conventional fluoroscopy-based balloon sizing revealed diameters of 17.5 +/- 5.4 mm, transesophageal echocardiography diameters of 11.8 +/- 3.3 mm (P < .001), and ICE measurement of native ASD diameters of 13.5 +/- 4.1 mm (P < .001). Single-plane ICE balloon sizing revealed diameters of 16.9 +/- 5.2 mm and corresponded well with fluoroscopy: R = 0.98, P < .001. As a sizing tool, ICE is an accurate alternative to fluoroscopy and helps to decrease radiation exposure.Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 06/2008; 21(6):737-40. · 2.98 Impact Factor