Author + information
- Received September 23, 2010
- Revision received October 11, 2010
- Accepted October 28, 2010
- Published online September 13, 2011.
- Christoph Hammerstingl, MD⁎,
- Georg Nickenig, MD, PhD⁎,
- Stefan Weber, MD, PhD† and
- Pascal Knuefermann, MD, PhD†
A 24-year-old man presented with multiple trauma after an automobile accident. The treatment course was complicated by progressive respiratory failure with need for extracorporeal membrane oxygenation. Two-dimensional transesophageal echocardiography showed a small ostium secundum atrial septal defect (ASD) with atypical right-to-left-shunting (A, Online Video 1) and severe tricuspid valve regurgitation (B, Online Videos 2 and 3). Real-time 3-dimensional (3D) transesophageal echocardiography (X7-2t matrix-array probe, Philips Medical Systems, Best, the Netherlands) unmasked a large interatrial septal slit (C, Online Video 4), resulting in a hemodynamically relevant defect area (D, reconstruction of ASD diameters and orifice area). Because provisional ASD closure during cardiac catheterization using an ASD sizing balloon markedly increased peripheral oxygenation (E), ASD occlusion was performed using an Amplatzer septal occluder (AGA Medical Corporation, Plymouth, Minnesota) (F, Online Video 5). Three days after ASD closure, extracorporeal membrane oxygenation was discontinued, and the patient was discharged in good medical condition.
This case illustrates that real-time 3D transesophageal echocardiography allows fast and accurate diagnosis of complex ASD anatomy and that offline anatomic reconstruction of 3D volume datasets provides important supplementary information that permits effective therapy.
- Received September 23, 2010.
- Revision received October 11, 2010.
- Accepted October 28, 2010.
- American College of Cardiology Foundation