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

Objectives: To define the utility of transesophageal echocardiography in pr edicting the likelihood of a successful procedure and residual shunting in patients undergoing transcatheter closure of defects within the oval fossa using the CardioSEAL(R) device. Background: Transesophageal echocardiograph y is used to monitor transcatheter closure of interatrial defects within th e the oval fossa, but predictors of successful closure and residual shuntin g have vet to be determined. Methods: We reviewed transesophageal echocardi ograms obtained from 26 consecutive patients undergoing attempted transcath eter 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 defeat was performed in 3 planes: longitudinal, 4-chamber, and basal short-axis. Results: Closure proved suc cessful in 24 patients (92%). The defect was significantly larger, and the anterosuperior rim of the defect smaller, in the 2 patients in whom occlusi on was not successful. Residual shunting 24 hrs after closure was detected in 14 patients. Significant predictors of leakage included smaller posterio r and superior rims, a larger shunt prior to closure, and herniation of a o ne left atrial arm of the device into the right atrium. In all cases, the s ites of leakage were the superior rim of the defect at the superior cavo-at rial junction, and the anterosuperior rim behind the aortic root. Herniatio n 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 wa s suboptimal in detecting residual leaks, and was enhanced substantially wi th the use of contrast echocardiography. Conclusions: Transesophageal echoc ardiography allows excellent assessment of the oval fossa and deficiencies of its floor in all of their dimensions. It is an important tool for guidin g the deployment of the occlusion device in patients undergoing attempted t ranscatheter closure of defects within the fossa. Contrast echocardiography should be used for optimal detection of residual shunting.