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Transesophageal echocardiographic predictors for successful transcatheter closure of defects within the oval fossa using the CardioSEAL® septal occlusion device

Published online by Cambridge University Press:  19 August 2008

Tarek S. Momenah ,
Doff B. McElhinney ,
Michael M. Brook ,
Phillip Moore  and
Norman H. silverman
Tarek S. Momenah
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Doff B. McElhinney
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Michael M. Brook
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Phillip Moore
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
Norman H. silverman
Affiliation:
Division of Pediatric Cardiology, University of California, San Francisco
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Abstract

Objectives

To define the utility of transesophageal echocardiography in predicting the likelihood of a successful procedure and residual shunting in patients undergoing transcatheter closure of defects within the oval fossa using the CardioSEAL® device.

Background

Transesophageal echocardiography is used to monitor transcatheter closure of interatrial defects within the the oval fossa, but predictors of successful closure and residual shunting have yet to be determined.

Methods

We reviewed transesophageal echocardiograms obtained from 26 consecutive patients undergoing attempted transcatheter closure of interatrial defects within the oval fossa between January, 1997 and May, 1998. Assessment of the atrial septum, the septal defect, and the rims of the oval fossa bordering the defect was performed in 3 planes: longitudinal, 4- chamber, and basal short-axis.

Results

Closure proved successful in 24 patients (92%). The defect was significantly larger, and the anterosuperior rim of the defect smaller, in the 2 patients in whom occlusion was not successful. Residual shunting 24 hrs after closure was detected in 14 patients. Significant predictors of leakage included smaller posterior and superior rims, a larger shunt prior to closure, and herniation of a one left atrial arm of the device into the right atrium. In all cases, the sites of leakage were the superior rim of the defect at the superior cavo-atrial junction, and the anterosuperior rim behind the aortic root. Herniation of a left atrial arm into the right atrium was seen in 7 patients (29%). In all, it was the anterosuperior arm which herniated Doppler color flow was suboptimal in detecting residual leaks, and was enhanced substantially with the use of contrast echocardiography.

Conclusions

Transesophageal echocardiography allows excellent assessment of the oval fossa and deficiencies of its floor in all of their dimensions. It is an important tool for guiding the deployment of the occlusion device in patients undergoing attempted transcatheter closure of defects within the fossa. Contrast echocardiography should be used for optimal detection of residual shunting.

Keywords

Atrial septal defectinterventional closuresecundum defects
Type
original-article
Information
Cardiology in the Young , Volume 10 , Issue 5 , September 2000 , pp. 510 - 518
Copyright
Copyright © Cambridge University Press 2000

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