CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
AFRICA
161
A comparison between size of the occluder device and
two-dimensional transoesophageal echocardiographic
sizing of the ostium secundum atrial septal defect
ALIMOHAMMAD HAJIZEINALI, HAKIMEH SADEGHIAN, MEHRNAZ REZVANFARD, MOHAMMAD ALIDOOSTI,
AREZOO ZOROUFIAN, MARAT A VOLMAN
Abstract
Objectives:
Transcatheter closure of a secundum atrial septal
defect (ASD II) has become an effective alternative for surgi-
cal treatment. In this study we evaluated the correlation
between the two-dimensional transoesophageal echocardio-
graphic (2D TEE) sizing of ASDs and the actual diameter of
occluders in patients undergoing device closure.
Methods:
The records of 54 patients who underwent trans-
catheter ASD closure were reviewed. ASD characteristics
and maximum defect diameter were evaluated using pre-
procedure 2D TEE images. Appropriate device size was
determined by the balloon sizing method, which measures
the balloon occlusive diameter (BOD) via TEE and fluor-
oscopy. ASD closure was performed under continuous TEE
monitoring using the Amplatzer occluder in all patients.
Results:
The mean of the TEE-derived maximum defect
diameter was significantly lower than the mean of the BOD
(17.8
±
4.5 vs 22.1
±
5.1 mm;
p
<
0.001) and the mean size of
the implanted occluder device (17.8
±
4.5 vs 23.3
±
5.1 mm;
p
<
0.001). However, a good correlation was found between the
TEE-derived defect size and the BOD (BOD
=
0.898
×
TEE
defect size
+
6.212,
R
=
0.824;
p
<
0.001) and between the TEE
measurement and the final size of the implanted Amplatzer
(device size
=
0.928
×
TEE defect size
+
6.853,
R
=
0.822;
p
<
0.001).
Conclusions:
2DTEE may provide a good equation to predict
the BOD or the size of the occluder device;
however, further
studies are needed to investigate whether it is feasible to
perform transcatheter ASD occlusion without balloon sizing.
Keywords:
atrial septal defect (ASD), occluder device, 2D TEE,
balloon sizing
Submitted 12/9/10, accepted 18/3/13
Cardiovasc J Afr
2013;
24
: 161–164
DOI: 10.5830/CVJA-2013-014
Atrial septal defect (ASD) is one of the most common lesions in
congenital heart disease.
1
The most frequent ASD is of the ostium
secundum type (ASD II), which constitutes approximately
7% of all cases of congenital heart disease,
2
and is suited for
transcatheter device closure.
3,4
Percutaneous closure of the ASD
II has been accomplished safely and effectively using several
different devices.
5-7
Accurate measurement of the size of the defect is of
paramount importance for the selection of an appropriate device
and its subsequent successful deployment. Implanting too large
a device may lead to a mushrooming deformity or cardiac
perforation or it may increase the risk of device erosion over
time,
8-10
while using too small a device has been accompanied
by device instability, distal embolisation of the device, and
residual shunting.
11,12
Balloon sizing of the defect has been
considered the gold standard for measuring ASD size,
13-18
while
angiography, transthoracic echocardiography (TTE), two- and
three-dimensional transoesophageal echocardiography (TEE),
intracardiac echocardiography, and intravascular ultrasound
have been tried as guiding methods during the closure
procedure.
10,14-16,18-20
Stretched balloon diameter (SBD) and balloon occlusive
diameter (BOD) are two measurements that have long been used
by interventionalists in the selection of an appropriate device size
for implantation.
17-19
However the balloon sizing method has its
disadvantages. Inflation of the balloon may enlarge the defect,
cause arrhythmias, or lead to hypotension due to decreased
diastolic filling.
21,22
Some investigators therefore consider this
cumbersome procedure unnecessary
7,23
and prefer less-invasive
measuring methods in the selection of the size of the ASD
closure device.
10,14,19,24
TEE is crucial for the assessment of ASD morphology.
19,23,25
Many studies have indicated the highly reliable role of TEE in
the prediction of BOD, SBD and device size.
10,15,17,19
We previously investigated the association between the BOD
and pre-procedure TEE-estimated defect size in a study with a
smaller sample size.
26
The main aim of the current study was to
compare the ASD II diameter obtained via TEE and the deployed
device size, and subsequently devise a formula for estimating the
appropriate device diameter using TEE measurement.
Methods
We retrospectively reviewed the records of patients with ASD
II considered for device placement at our institution from July
Interventional Cardiology Department, Tehran Heart Centre,
Tehran University of Medical Sciences, Tehran, Iran
ALIMOHAMMAD HAJIZEINALI, MD
MOHAMMAD ALIDOOSTI, MD
Echocardiography Department, Tehran Heart Centre, Tehran
University of Medical Sciences, Tehran, Iran
HAKIMEH SADEGHIAN, MD,
AREZOO ZOROUFIAN, MD
Research Department, Tehran Heart Centre, Tehran
University of Medical Sciences, Tehran, Iran
MEHRNAZ REZVANFARD, MD
Department of Medicine, Division of Cardiology, David
Geffen School of Medicine at UCLA, Los Angeles, California
MARAT A VOLMAN, MA
