Echocardiographic guidance during placement of the buttoned double-disk device for atrial septal defect closure.
The usefulness of two-dimensional and Doppler echocardiography during buttoned double-disk device closure of an atrial septal defect was evaluated in 20 consecutive patients at the time of interventional catheterization.  Transesophageal echocardiography was used in 11 patients (ages 5 to 62 years, weights 20 to 91 kg).  Because of the size of the available transesophageal echo probe, transthoracic echocardiography was used in the remaining 9 patients (ages 4 to 5.5 years, weights 14 to 21 kg).  In the transesophageal echo group, 1 patient was found to have no atrial septal defect despite a previous diagnosis by transthoracic echocardiography, 3 patients had atrial septal defects too large for closure despite attempts in 2, and 7 patients had transesophageal echo guided device placement.  All of these 7 patients had small residual shunts by color Doppler, 2 had unusual arm positions, and 2 had surgical removal of the device due to embolization to the pulmonary artery in 1 and failure to obtain close approximation of the occluder and counteroccluder in 1.  In the transthoracic echo group, 2 patients had atrial septal defects too large for closure, 1 patient had no femoral venous access, and 6 patients had transthoracic echo guided device placement.  All of these 6 patients had small residual shunts by color Doppler and 3 of the 6 had unusual arm positions.  For atrial septal defect sizing, transesophageal echo measurements correlated with catheter balloon size more closely than did transthoracic echo measurements (r 2 = 0.97 vs 0.86).(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor.
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Snider
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D004868:Equipment Failure; D005069:Evaluation Studies as Topic; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016896:Treatment Outcome