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EXPEDITED REVIEW

Intracardiac echocardiography-guided transcatheter closure of secundum atrial septal defect

A new efficient device selection method

Mario Zanchetta, MD^*,*, Eustaquio Onorato, MD, Gianluca Rigatelli, MD^*, Luigi Pedon, MD^*, Marco Zennaro, MD^*, Antonio Carrozza, MD^* and Pietro Maiolino, MD^*

^* Department of Cardiovascular Disease, Cittadella General Hospital, Via Riva Ospedale, Padua, Italy
Division of Cardiology, Humanitas Gavazzeni, Bergamo, Italy

^* Reprint requests and correspondence to: Dr. Mario Zanchetta, Dipartimento di Malattie Cardiovascolari, Ospedale Civile, Via Riva Ospedale, 35013, Cittadella, Padova, Italy.
emodinacit{at}ulss15.pd.it

OBJECTIVES: We assessed the use of intracardiac echocardiography (ICE) as the primary means for both selection of the Amplatzer Septal Occluder (ASO) and the guidance of transcatheter closure of secundum atrial septal defects (ASDs).

BACKGROUND: The standard method for transcatheter closure of ASDs requires balloon-sizing maneuver and transesophageal echocardiographic (TEE) monitoring. The role of ICE during transcatheter closure of ASDs has not yet been established.

METHODS: In 91 patients with ASDs, two standardized orthogonal sections were used to obtain ICE-derived measurements of the fossa ovalis and to assess optimal device deployment: the transverse section on the aortic valve plane, and the longitudinal section on the four-chamber plane.

RESULTS: In all patients, ICE planes were identified with excellent resolution, providing proper measurements of the fossa ovalis, from which to derive geometric assumptions for the selection of an appropriately sized device. The ASO waist diameter was chosen on the basis of the r value (r = c² + p², where r is the radius of an ideal circle that intersects the elliptical fossa ovalis in its semi-latus rectum, c is the foci half-distance of the fossa ovalis, and p is its semi-latus rectum). During the procedure, the four-chamber plane allowed us to obtain easily interpretable images of all stages of device deployment. Midterm complete occlusion rate was 97.8%. No ICE-related complications occurred.

CONCLUSIONS: The ICE evaluation of ASDs allows quantitative and qualitative information for both proper ASO selection and optimal device placement, thus eliminating the cumbersome balloon-sizing maneuver and the need for general anesthesia during TEE monitoring.

Abbreviations and Acronyms   ASD = secundum atrial septal defect   ASO = Amplatzer Septal Occluder   ECG = electrocardiography   ICE = intracardiac echocardiography   TEE = transesophageal echocardiography

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