2-DIMENSIONAL AND 3-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN PATIENT SELECTION AND ASSESSMENT OF ATRIAL SEPTAL-DEFECT CLOSURE BY THENEW DAS-ANGEL WINGS DEVICE - INITIAL CLINICAL-EXPERIENCE

Background Transcatheter closure of atrial septal defects (ASDs) has b een feasible and successful. Two-dimensional echocardiography (2DE) wa s applied to patients before selection and during device deployment. T hree-dimensional echocardiography (3DE) can provide unique anatomic pe rspectives that might aid in improving device closure of ASDs. Methods and Results Twenty-two consecutive patients were enrolled in an initi al protocol for ASD device closure by the new DAS-Angel Wings occluder device. On the basis of transesophageal (TEE) 2DE and 3DE, 13 patient s were considered eligible for device closure (9 secundum ASDs and 4 w ith patent foramen ovale associated with a cerebral vascular accident) . Maximal ASD diameter and surrounding rim tissues were compared by TE E 2DE and 3DE and with balloon sizing measurements at catheterization. ASD size measured by TEE 2DE and 3DE correlated well (y = 1.0x + 0.04 9, r=.95), with good limits of agreement. However, balloon-stretched d iameter measurements were systematically larger than echocardiographic measurements. Rim tissue measurements correlated well; however, TEE 3 DE could demonstrate the entire shape and perimeter of the defect. Two -dimensional imaging provided reliable information during device deplo yment and for closure of small ASDs. However, 3DE was superior for ima ging the device, especially when abnormally placed. Conclusions Three- dimensional imaging provides unique images and projections that were e ssential for understanding the spatial relationship of the device to t he atrial septum. Three-dimensional echocardiography significantly enh anced our understanding of two-dimensional images and provided an imag ing conceptualization that should aid in future development of device closures.