Three-dimensional echo and videocardioscopy-guided atrial septal defect closure.
BACKGROUND
Current real-time three-dimensional echocardiography systems (RT3DE) can provide sufficient visualization to permit atrial septal defect (ASD) closure. However, detailed visualization of small objects inside the heart is still suboptimal because of limited resolution, which is a limitation for clinical application. We evaluate the complementary use of videocardioscopy in image-guided ASD closure.


METHODS
In a pig model (n = 5), a 4-mm to 8-mm ASD was created with RT3DE guidance. Defect closure was accomplished with a catheter-based patch-delivery system fixed around the defect with mini-anchors under combined RT3DE and videocardioscopy guidance. The endoscope was inserted into the heart through a custom built port designed to allow visualization in the presence of blood.


RESULTS
All ASDs were successfully closed. The combination of RT3DE and videocardioscopy allowed detailed visualization of intracardiac structures, instruments, patch, and mini-anchors.


CONCLUSIONS
Beating-heart ASD closure can be achieved with combined RT3DE and videocardioscopy imaging. Use of videocardioscopy provides high-resolution imaging and likely improves safety of the image-guided procedure.
Vasilyev
Nikolay V
NV
Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.
Martinez
Joseph F
JF
Freudenthal
Franz P
FP
Suematsu
Yoshihiro
Y
Marx
Gerald R
GR
del Nido
Pedro J
PJ
D000818:Animals; D001672:Biocompatible Materials; D006348:Cardiac Surgical Procedures; D002404:Catheterization; D004195:Disease Models, Animal; D019560:Echocardiography, Three-Dimensional; D004724:Endoscopy; D006344:Heart Septal Defects, Atrial / Q000601:surgery*; D011093:Polyethylene Terephthalates; D025321:Surgery, Computer-Assisted; D013552:Swine; D014741:Video Recording
D001672:Biocompatible Materials; D011093:Polyethylene Terephthalates