Circulation: Cardiovascular Imaging. 2008;1:e15-e16
doi: 10.1161/CIRCIMAGING.108.774570
Percutaneous Closure of Multiple Secundum Atrial Septal Defects Using 3 Amplatzer Atrial Septal Occluder Devices
Evaluation by Live Transthoracic 3-Dimensional Echocardiography
Carmelo Arcidiacono, MD
;
Gianpiero Gaio, MD
;
Gianfranco Butera, MD
and
Mario Carminati, MD
From the Department of Pediatric Cardiology (C.A., G.B., M.C.), Istituto Policlinico San Donato IRCCS, San Donato Milanese, Italy; and the Department of Pediatric Cardiology (G.G.), Seconda Università degli Studi, Azienda Ospedaliera Monaldi, Napoli, Italy.
Correspondence to Carmelo Arcidiacono, MD, Department of Pediatric Cardiology, Istituto Policlinico San Donato IRCCS, Via Morandi 30, 20097 San Donato Milanese, Italy. E-mail c_arcidiacono{at}hotmail.com
A previously healthy 12-year-old boy was admitted to the hospital with acute pneumonitis. On admission, a heart murmur was detected. The transthoracic echocardiogram showed multiple secundum atrial septal defects with left-to-right shunt and signs of right ventricular volume overload. He underwent right cardiac catheterization and transesophageal echocardiogram (transesophageal echocardiography): 3 sizeable atrial septal defects (anterosuperior, measuring 10 mm; posterior, 9 mm; anteroinferior, 6 mm) were closed with 3 Amplatzer atrial septal occluder devices, measuring 10, 9, and 6 mm (Figures 1 and 2
). A good result was achieved, with no residual shunt across the atrial septum and no complications. The live transthoracic 3D (Figures 3 and 4, Data Supplement Movies I and II) and concurrent transesophageal echocardiography assessment at the end of the procedure showed good position of the devices, no residual interatrial shunts, no interference with the atrioventricular valves, and no obstruction to the venous returns.
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Figure 2. Angiographic image of the 3 Amplatzer atrial septal occluder devices after release, indicated by the black arrows. In the bottom right corner, the delivery sheath is visible.
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To our knowledge, there have been no previous reports of 3D
echocardiographic imaging after transcatheter closure of multiple
atrial septal defects using 3 devices.
1 Few previous reports
focus on the initial results of 3D echocardiographic analysis
based on image acquisition and offline postprocessing.
2,3 Live
transthoracic 3D echocardiography was used for the first time
to evaluate the postprocedural results, and it proved to be
a useful tool to assess the spatial relationship between the
devices and with the surrounding structures.
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Disclosures
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None.
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Footnotes
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The online-only Data Supplement is available at http://circimaging.ahajournals.org/cgi/content/full/1/2/e15/DC1
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References
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1. Awad SM, Garay FF, Cao QL, Hijazi ZM. Multiple Amplatzer septal occluder devices for multiple atrial communications: immediate and long-term follow-up results.
Catheter Cardiovasc Interv. 2007; 70: 265–273.
[CrossRef][Medline]2. Cao Q, Radtke W, Berger F, Zhu W, Hijazi ZM. Transcatheter closure of multiple atrial septal defects. Initial results and value of two- and three-dimensional transoesophageal echocardiography. Eur Heart J. 2000; 21: 941–947.[Abstract/Free Full Text]
3. Correia DM, Ribeiro J, Fonseca C, Goncalves M, Braga P, Ribeiro VG. Three-dimensional assessment of a percutaneous transcatheter atrial septal defect closure with an Amplatzer device. Rev Port Cardiol. 2005; 24: 1293–1295.[Medline]
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Disclosures
References