title: Echocardiographic evaluation of iatrogenic atrial septal defect after catheter-based mitral valve clip insertion.
abstract: The geometries and sizes of persistent iatrogenic atrial septal defects (IASDs) after transseptal puncture during catheter-based mitral valve clip insertion (MVCI) have not been detailed. In this study, 11 IASDs were investigated in 10 patients who underwent MVCI using a guide catheter (24Fr proximally and 22Fr at the atrial septum). The diameters of the long and short axes and the area at maximum and minimum during a cardiac cycle were measured after MVCI using real-time 3-dimensional (RT3D) transesophageal echocardiography (TEE). A circular shape was assumed on 2-dimensional TEE, resulting in an area calculation of π × (dimension/2)(2). The anatomic geometries of IASDs were visualized in a 3-dimensional en face view of the atrial septum. Furthermore, 1 month after MVCI, IASDs were evaluated using echocardiography. The IASDs had a variety of irregular geometries. The mean long-axis diameter was 1.0 ± 0.24 cm, the mean short-axis diameter was 0.51 ± 0.22 cm, and the mean area was 0.40 ± 0.24 cm(2) on RT3D TEE. The diameters and area changed significantly between the maximal and minimal values during the cardiac cycle. Importantly, 2-dimensional TEE underestimated the maximal diameters of IASDs (0.54 ± 0.17 vs 1.0 ± 0.24 cm by RT3D TEE, p <0.01) and the maximal areas of IASDs (0.25 ± 0.15 vs 0.40 ± 0.23 cm(2) by RT3D TEE, p <0.05). One month after MVCI, the smallest and the second smallest IASDs had closed, and the other 9 remained open. In conclusion, RT3D TEE is useful to assess the irregular geometries of IASDs created during MVCI.
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, and UCLA, Los Angeles, California, USA.
authors.forename: Takeji
authors.initials: T
authors.lastname: Saitoh
authors.forename: Masaki
authors.initials: M
authors.lastname: Izumo
authors.forename: Azusa
authors.initials: A
authors.lastname: Furugen
authors.forename: Jun
authors.initials: J
authors.lastname: Tanaka
authors.forename: Yoko
authors.initials: Y
authors.lastname: Miyata-Fukuoka
authors.forename: Swaminatha V
authors.initials: SV
authors.lastname: Gurudevan
authors.forename: Kirsten
authors.initials: K
authors.lastname: Tolstrup
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D013525:Surgical Instruments