BIPLANE TRANSESOPHAGEAL ECHO-DOPPLER STUDIES OF ATRIAL SEPTAL-DEFECTS- QUANTITATIVE-EVALUATION AND MONITORING FOR TRANSCATHETER CLOSURE

Forty-four patients with atrial septal defects, aged 7 months to 18 ye ars (median 8.9), underwent biplane transesophageal (TEE) and transtho racic (TTE) echocardiography. The size of the defect and the shunt flo w volume were measured by TEE and compared with the actual size at sur gery (N = 14) or the shunt volume measured by the Fick method (N = 34) , respectively. In all cases the location and morphology of the defect were clearly demonstrated by TEE; on the other hand, two patients wit h sinus venosus-type and multiple-type defects, respectively, and one with a small ostium primum defect did not have a complete diagnosis by TTE. The defect size determined by TEE correlated well with the surgi cal measurement. Similarly a significant correlation was demonstrated between the shunt volume measured by TEE and that obtained by the Fick method. In three patients transcatheter closure of the atrial septal defect by means of a clamshell device was accomplished successfully wi th TEE monitoring. We conclude that biplane TEE provides a better appr eciation of cardiac anatomy and hemodynamic evaluation than TTE in thi s setting, and TEE is essential for monitoring during transcatheter cl osure.