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Background: Percutaneous closure of atrial septal defect (ASD) is safe and effective. Fluoroscopic balloon sizing during the catheterization usually will lead to an over estimation of ASD size. Three-dimensional transoesophageal echocardiography (3D-TEE) permits the ASD morphology to be assessed comprehensively. The purpose of this study was to assess the relationships between the measurements and shape of ASDs by 2D-, 3D-TEE, and fluoroscopic balloon sizing in adult.
Methods: 120 patients who underwent percutaneous closures of a single ASD were enrolled from 2010 till 2015. ASD diameters were measured by 2D-transthoracic echocardiography (TTE), 2D-TEE, 3D-TEE and compared with fluoroscopic balloon sizing. The ASD area was measured on 3D-TEE images with multi-plane reconstruction. ASD was estimated as round or oval shape on 3D-TEE ‘en-face’ view.
Results: 2D-TTE, 2D-TEE, and 3D-TEE(max) ASD diameters were well correlated with BS (r = 0.70; 0.81, and 0.87, respectively). Mean diameters were all significantly smaller than the mean balloon sizing. The mean difference between the balloon area and 3D-TEE area was 1.5 ± 1.2 cm2 (P < 0.0005). The mean difference between balloon sizing and 3D-TEE(max) diameters was higher in round ASDs than in oval ASDs (4.2 ± 3.1 vs. 1.3 ± 3.2, P = 0.03). With multivariate linear regression analysis, two formulas were built to predict balloon sizing. The first model was balloon sizing = 1.07 × 3D-TEE(max)- 3.1 × ASD shape + 3. The ASD shape was 0 for round and 1 for oval ASDs. A second model was Balloon sizing = 4.5 × ASD area + 11.5.
Conclusions: The ASD shape can be accurately estimated by 3D-TEE and influences the relationship between echocardiographic measurements and balloon sizing. The ASD shape, its maximal diameter and the area assessed by 3D-TEE is sufficient to determine the device size without balloon sizing during percutaneous closure.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Applications of Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1160-218
- 2017 American College of Cardiology Foundation