Influence of atrial septal defect anatomy in patient selection and assessment of closure with the Cardioseal device - A three-dimensional transoesophageal echocardiographic reconstruction

Background The maximal diameter of the defect and the dimensions of the sep tal rims are essential parameters for the selection of optimal cases for de vice closure. Neither two-dimensional echocardiography nor balloon catheter sizing provide optimal data. Unique three-dimensional echocardiography mig ht help to improve patient selection and assessment of results. Our aim was to optimize transcatheter closure of secundum type atrial septal defects u sing three-dimensional echocardiography. Methods Sixteen patients enrolled in a protocol for atrial septal defect tr anscatheter closure with the Cardioseal device underwent transoesophageal t wo- and three-dimensional echocardiography. Maximal diameter and tissue rim of the atrial septal defect were measured and compared by both methods. In the 12 patients selected for closure, the balloon stretched diameter was c ompared to three-dimensional echocardiography measurements. Device placemen t was assessed by two- and three-dimensional echocardiography. Results The shape of the atrial septal defect appeared variable on three-di mensional views: round in nine patients but complex (oval, raquet-shaped, m ultiple) in seven patients. The surface area of the atrial septal defect va ried by 68 +/- 15% during the cardiac cycle. The correlation between atrial septal defect maximal diameters measured by two-dimensional transoesophage al echocardiography and three-dimensional echocardiography was better in ro und defects (y=1 x +1.6, r=0.99) than in complex defects (y=0.7 x -0.5, r=0 .88). The antero-superior rim could only be properly assessed by three-dime nsional echocardiography. In 12 patients the correlation between stretched diameter and three-dimensional echocardiography maximal diameter was poor ( y=0.3 x +13, r=0.41). After placement of the device, three-dimensional echo cardiography enabled the mechanism of residual shunting to be understood in three patients. Conclusions Dynamic three-dimensional echocardiography enhances the underst anding of the anatomy and physiology of atrial septal defect and should be an important process in future initiatives for device closures.