EXPANDED ROLE FOR TRANSOESOPHAGEAL ECHOCARDIOGRAPHY IN
PERCATHETER CLOSURE OF ATRIAL SEPTAL DEFECTS. R
Graham*, J Gelman, D McGaw, RW Harper. Cardiology
Unit, Monash Medical Centre and Centre for Heart and Chest Research, Monash
University, Clayton, Victoria. Transoesophageal
echocardiography (TOE) constitutes an essential part of the percatheter closure
of secundum atrial septal defects (ASD), with major procedural roles related to
sizing of the defect and guiding device deployment. Our experience of percatheter ASD closures performed in 31
patients [24 female, mean age 46 yrs] over a year period has, however, pointed
to an expanded role for the use of TOE with such closures, which covers three
broad areas. 1)
Closure
of complex defects. Our patient cohort
has included three patients with a fenestrated aneurysmal septum, closed with
an Amplatzer PFO closure device. In
these cases TOE confirmed passage of the delivery catheter across a central
defect and ensured that the atrial discs covered the additional fenestrations.
Another patient had two discrete secundum ASDs which were successfully closed
with 2 Amplatzer devices. 2)
Detection
of unexpected procedural complications.
In our patient series, TOE has detected unexpected events including the
development of thrombus on the delivery catheter and herniation of the Chiari
network into the left atrium after entanglement with the closure device. In both cases, catheter withdrawal prevented
further complications. In another instance, TOE revealed that the onset of
haemodynamic instability during balloon sizing of an inferior ASD was related
to obstruction
of the inferior vena cava by the inflated balloon. 3)Long-term
followup. At our institution, a
follow-up TOE is routinely performed at 1 and 12 months after ASD closure to
confirm satisfactory device position and assess the degree of residual
shunt. However, in one patient of our
series, a thrombus was detected on a closure device at the 1 TOE month study,
which resolved after institution of anticoagulation therapy. Conclusion:
Increasing experience with the percatheter ASD closure technique has pointed to
an expanded role for TOE, not only in the periprocedural, but also in the
follow-up phase.
