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Intracardiac echocardiography guided device closure of atrial septal defects

Michael J. Mullen, MD, MRCP^*,*, Bryan F. Dias, MD^*, Fiona Walker, MD, MRCP^*, Samuel C. Siu, MD, SM^*, Lee N. Benson, MD, FACC and Peter R. McLaughlin, MD, FACC^*

^* University of Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, Toronto, Canada
Division of Cardiology, The Hospital for Sick Children, Toronto, Canada

View larger version (69K): [in a new window]   Figure 1 Fluoroscopic position of the intracardiac transducer with corresponding echocardiographic images. (A) Long-axis view of the tricuspid valve (TV), right ventricle (RV), and right ventricular outflow tract viewed from the right atrium (RA). (B) Rotation of the catheter clockwise reveals a long-axis view of atrial septum and the left atrium (LA); color Doppler demonstrates an atrial septal defect. (C) Advancing the transducer cranially with slight posterior flexion reveals the sinus venosus septum, superior vena cava (SVC), and origin of the right upper pulmonary vein (RUPV). (D) Further posterior flexion and rotation of the transducer towards the TV provides a short-axis image of the aorta (Ao), atrial septum, and atrial septal defect.

View larger version (42K): [in a new window]   Figure 2 (A) Amplatzer septal occluder with both left atrial (LA) and right atrial (RA) discs visible during deployment. (B) Short-axis view of Amplatzer device following deployment. (C and D) Long-axis views illustrating capture of the membranous inferior and muscular superior septum.

View larger version (73K): [in a new window]   Figure 3 Adverse procedural events detected by intracardiac echocardiography. (A and B) Malpositioned Cardioseal and Amplatzer devices with both discs on right atrial (RA) side of aorta (Ao). (C) Color flow demonstrates a residual leak in this patient, with two devices already deployed. Intracardiac echocardiography demonstrated this to be a small additional fenestration. (D) This second large inferior defect was not identified by transesophageal echocardiography. Note the sizing balloon inflated within a more superior defect and the coronary sinus (CS) and mitral valve (MV).