Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-08T15:29:35.703Z Has data issue: false hasContentIssue false
  • English
  • Français

Transcatheter closure of atrial septal defects under echocardiographic guidance without X-ray: initial experiences

Published online by Cambridge University Press:  19 August 2008

Peter Ewert ,
Ingo Daehnert ,
Felix Berger ,
Andreas Kaestner ,
Gregor Krings ,
Michael Vogel  and
Peter E. Lange
Peter Ewert*
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Ingo Daehnert
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Felix Berger
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Andreas Kaestner
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Gregor Krings
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Michael Vogel
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
Peter E. Lange
Affiliation:
Department of Congenital Heart Defects, German Heart Institute, Berlin, Germany
*
Peter Ewert, MD, Dept. of Pediatric Cardiology, German Heart Institute, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: ++ 49/30-4593-2800; Fax: ++ 49/30-4593-2900; email:[email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Transcatheter closure of atrial septal defects is performed under fluoroscopy, but echocardiography has gained an important role in the procedure. With the new Amplatzer Septal Occluder a device has become available which is easy to implant with minimal fluoroscopy time. We developed an interventional procedure with this device under transesophageal echocardiography alone without fluoroscopy.

Methods and Results

Four patients (3 to 16 years of age, bodyweight 14 to 60 kg) with atrial septal defects centrally located in the oval fossa were elected for transcatheter closure. After sedation with midazolam and propofol a diagnostic and interventional catheterization was performed in all cases without fluoroscopy. Oxymetric shunt was Qp: Qs = 1.7 (1.5 to 2.1). Under transesophageal echocardiography, the defects were sized over the wire with a balloon catheter. Mean balloon stretched diameter was 10 mm (7 to 14 mm). Under transesophageal echocardiography an Amplatzer Septal Occluder was placed into the defect. In two patients this was achieved with a 5 MHz monoplane pediatric transducer, in two patients a 10mm 5 MHz multiplane probe was used. Complete closure was achieved in all patients and no complications were encountered.

Conclusion

We conclude that in selected cases with an atrial septal defect located in the oval fossa and clear-cut echocardiographic findings, an Amplatzer Septal Occluder can be safely deployed under echocardiographic guidance alone.

Keywords

atrial septal defectinterventional cardiologytransesophageal echocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 2 , March 1999 , pp. 136 - 140
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.King, TD, Thompson, SL, Steiner, C, Mills, NL. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA 1976; 235: 2506–2509.Google Scholar
2.Rao, PS, Sideris, EB, Hausdorf, G, Rey, C, Lloyd, TR, Beekman, RH, Worms, AM, Boulon, F, Onorato, E, Khalilullah, M, al. e. International experience with secundum atrial septal defect occlusio by the buttoned device. Am Heart J 1994; 128: 1022—1035.Google Scholar
3.Sievert, H, Babic, UU, Ensslen, R, Scherer, D, Spies, H, Wiederspahn, T, Zeplin, HE. Transcatheter closure of large atrial septal defects with the Babic system. Cather Cardiovasc Diagen 1995; 36: 232–240.CrossRefGoogle ScholarPubMed
4.Magni, G, Hijazi, ZM, Pandian, NG, Delabays, A, Sugeng, L, Laskari, C, Marx, GR. Two–and three–dimensional transesophageal echocardigraphy in patient selection and assessment of atrial septal defect closure by the new DAS–Angel Wings device: initial clinical experience. Circulation 1997; 96: 1722–1728.Google Scholar
5.Bjormstad, PG, Masura, J, Thaulow, E, Smevik, B, Mivhelesen, SS, Tonessen, TI, Seem, E, Fosse, E. Interventional closure of atrial septal defects with the Amplatzer device: first clinical experience. Cardiol Yong 1997; 7: 277–283Google Scholar
6.Reddy, SC, Rao, PS, Ewenko, J, Koscik, R, Wilson, AD. Echocardiographic predictors of success of catheter closure of atrial septal defect with the buttoned device. Am Heart J 1995; 129: 76—82.CrossRefGoogle ScholarPubMed
7.Ewert, P, Berger, F, Daehnert, I, Krings, G, Lange, PE. Transcathere occlusion of atrial septal defects with the Amplatzer Septal Occluder {abstract in German}. Z Kardiol 1988; 85: 747.Google Scholar
8.Bierman, FZ. Two–dimensional echocardiography and its influence on cardiac catheterization. Cardiovasc Intervent Radiol 1984; 7: 140–153.Google Scholar
9.Kultursay, H, Turkoglu, C, Akin, M, Payzin, S, Soydas, C, Akilli, A. Mitral balloon valvuloplasty with transesophageal echocardiography without using fluoroscopy. Cather Cardiovase Diagn 1992; 27: 317–321.CrossRefGoogle ScholarPubMed
10.Saleh, MA, ELFiky, AA, Fahmy, M, Farag, N, Khashaba, AA. Use of biplane transesophageal echocardiography as the only imaging technique for percutaneous ballon mitral commissurotomy. Am J Cardiol 1996; 78: 103–106.CrossRefGoogle Scholar
11.Weber, HS, Mart, CR, Kupferschmid, J, Myers, JL, Cyran, SE. Transcarotid ballon valvuloplasty guidance for neonatal critical aorric valve stenosis: an alternative to surgical palliation. Pediatric Cardiol 1998; 19: 212–217.Google Scholar
12.Allan, LD, Leanage, R, Wainwright, R, Joseph, MC, Tynan, M. Balloon atrial septostomy under two dimensional echocardiographic control. Br Heart J 1982; 47: 41–43.Google Scholar
13.Ewert, P, Daehnert, I, Berger, F, Kaestner, A, Lange, PE. Closure of an atrial septal defect without surgery and without x–ray {German}. Z Herz Thorax Gefásschirurgie 1998; 12: 221–225.Google Scholar
14.Berger, F, Ewert, P, Stiller, B, Daehnert, I, Krings, G, Vogel, M, Lange, PE. Inital clinical results with the Amplatzer septal occluder—a self–centering double dise for occlusion of atrial septal defects. Z Kardiol 1988; 87: 185–190.Google Scholar
15.Formigari, R, Rinelli, G, Santoro, G, Rossetti, L, Guccione, P, Ballerinit, L. Single–center experience with three different atrial septal defect closure devices. Comparative study [abstract]. Cardio Young 1998; 9 suppl 1: 40.Google Scholar
16.Walsh, KP, Tofeig, M, Peart, I, Kitchiner, DJ, Arnold, R. Comparative effectiveness of the Sideris and Amplatzer septal occlusion devices {abstract}. Cardiol Young 1998; 9: Suppl 1: 11–12.Google Scholar
17.Masura, J, Gavora, P, Formanek, A, Hijiazi, ZM. Transcatheter closure of secundum atrial septal defects using the new self–centering amplatzer septal occluder: initial human experience. Cather Cardiovas Diagn 1997; 42: 388–393.Google Scholar
18.Shub, C, Tajik, AJ, Seward, JB, Hagler, DJ, Danielson, GK. Surgical repair of uncomplicated atrial septal defect without ‘routine’ preoperative cardiac catheterization. J Am Coll Cardiol 1985; 6: 49–54.Google Scholar
19.Marek, J, Skovranek, J, Hucin, B, Chaloupecky, V, Reich, O, Samanek, M. Seven–year experience of noninvasive preoperative diagnostics in children with congenital heart defects: comprehensive analysis of 2,788 consecutive patients. Cardiology 1995; 86: 488–495.Google Scholar