Sizing of atrial septal defects - to predict successful closure with transcatheter CardioSEAL (TM) device

We conducted this retrospective study to compare methods for measuring atri al septal defects and to identify factors affecting echocardiographic measu rement of such defects before transcatheter closure with the CardioSEAL (TM ) Septal Occluder We reviewed the records of patients considered for device placement at our institution from January 1997 to April 1999. Atrial septa l defect size was measured by transthoracic and transesophageal echocardiog raphy; the stretched diameter was measured during catheterization by fluoro scopy and transesophageal echocardiography. The stretched-diameter fluorosc opic measurement was used for device size selection. Analysis of variance w as used to calculate the effect of size, age, and size-by-age interaction. Thirty-one patients (3.3 to 72 years of age) underwent transthoracic and tr ansesophageal echocardiography One patient was excluded from catheterizatio n because of a 25-mm septal defect as indicated by transesophageal echocard iography (our maximum diameter 15 mm). Thirty patients underwent transcathe ter stretched-diameter sizing; 5 were excluded from device implantation bec ause of defects > 20 mm by stretched-diameter fluoroscopy (4) or septal len gth insufficient for device support (1). Implantation was successful in 23/ 25 patients; 2/23 had a residual shunt. In patients with available results (26/30), the stretched diameter was the same whether measured by stretched- diameter fluoroscopy or transesophageal echocardiography (P=0.007, R square =0.963). Compared with stretched-diameter fluoroscopy, precatheterization t ransthoracic and transesophageal echocardiography underestimated defect siz e by a mean of 22% and 13.2%, respectively. When data from those same tests were compared in defects of less than or equal to 70 mm and > 10 mm, trans thoracic and transesophageal echocardiography were reliable predictors (P=0 .003 and P=0.05, respectively) of stretched-diameter size in defects less t han or equal to 10 mm.