ECHOCARDIOGRAPHIC GUIDANCE DURING PLACEMENT OF THE BUTTONED DOUBLE-DISK DEVICE FOR ATRIAL SEPTAL-DEFECT CLOSURE

The usefulness of two-dimensional and Doppler echocardiography during buttoned double-disk device closure of an atrial septal defect was eva luated in 20 consecutive patients at the time of interventional cathet erization. Transesophageal echocardiography was used in 11 patients (a ges 5 to 62 years, weights 20 to 91 kg). Because of the size of the av ailable transesophageal echo probe, transthoracic echocardiography was used in the remaining 9 patients (ages 4 to 5.5 years, weights 14 to 21 kg). In the transesophageal echo group, 1 patient was found to have no atrial septal defect despite a previous diagnosis by transthoracic echocardiography, 3 patients had atrial septal defects too large for closure despite attempts in 2, and 7 patients had transesophageal echo guided device placement. All of these 7 patients had small residual s hunts by color Doppler, 2 had unusual arm positions, and 2 had surgica l removal of the device due to embolization to the pulmonary artery in 1 and failure to obtain close approximation of the occluder and count eroccluder in 1. In the transthoracic echo group, 2 patients had atria l septal defects too large for closure, 1 patient had no femoral venou s access, and 6 patients had transthoracic echo guided device placemen t. All of these 6 patients had small residual shunts by color Doppler and 3 of the 6 had unusual arm positions. For atrial septal defect siz ing, transesophageal echo measurements correlated with catheter balloo n size more closely than did transthoracic echo measurements (r(2), 0. 97 vs 0.86). Echocardiography was particularly useful for sizing the d efect in two orthogonal views (n = 18), sizing total atrial septal len gth to determine maximum usable device size(n = 15), imaging septal ri ms(n = 19), determining effectiveness of balloon occlusion for sizing (n = 16), placement of occluder and counteroccluder (n = 15), detectin g residual shunts (n = 15), and detecting unusual arm positions with o r without new-onset valve regurgitation (n = 5). Thus, echocardiograph ic imaging is an essential component of atrial septal defect closure d uring cardiac catheterization.