Figure 1.
Measurement of ASD diameter and surrounding rims using TTE in different cross sections in a patient with ASD and a deficient superior-anterior rim.
(A) Parasternal short-axis view showing measurement of the ASD diameter and the length of superior-posterior rim. The superior-anterior rim was absent. (B) Apical four chamber view showing measurement of the ASD diameter and the rim length from ASD to the mitral annulus and to the top of the atrium. (C and D) Subcostal view showing measurement of the ASD diameter, total atrial septal length, and rim length from the ASD to the mitral annulus and the superior vena cava (SVC) and inferior vena cava (IVC) entrances. Distance from “a” to “b” is the rim length of the SVC side, “c” to “d” rather than “c” to “e” is the rim length of the IVC side. The distance from “d” to “e” is the posteroinferior wall of the right atrium. ASD = atrial septal defect, AO = ascending aorta, LA = left atrium, RA = right atrium, LV = left ventricle, RV = right ventricle, IVC = inferior vena cava, SVC = superior vena cava.
Figure 2.
Fluoroscopy images of the Amplatzer-type septal occluder (ASO) in a patient with ASD and a deficient superior-anterior rim.
(A and B) The two discs were seen separating clearly in the postero-anterior view, and the upper part of the left disc was shaped like a “beret” (arrow) in the left anterior oblique position, which demonstrated that the left disc upper part had already slipped into the right atrium. (C) The left disc was opened, and most of the waist was in the left atrium in an attempt to position the waist horizontally and to straighten the left disc. (D and E) The catheter sheath was introduced into right upper pulmonary vein, the catheter was pulled to the left atrium with the catheter orientation kept to the right upper side of the left atrium, and the whole left disc was open. (F and G) When the ASO was fully open at the ASD, the left and right discs were overlapped in the postero-anterior view and the upper part of the two discs were opened widely in a “Y” shape in the 45°–80° left anterior oblique view, the proper ASO position was assumed. (H) The ASO was released and the two discs were clearly separated.
Figure 3.
TTE images of the ASO in a patient with ASD with a deficient superior-anterior rim.
(A) The left disc upper part was seen to be slipped into the right atrium (curved arrow). (B) After adjusted deployment, the upper parts of the two discs were positioned on the left and right side of the ascending aorta separately and opened as a “Y” shape (dashed and curved arrows). (C) No residual shunt was detected. The cable was pushed to make the right disc upper part press the ascending aorta tightly as shown in the parasternal short-axis view (D) and apical four-chamber view (E). After the ASO was released, the two ASO disc upper parts were positioned on the left and right side of the ascending aorta separately (curved arrows) (F) and no residual shunt was detected as shown in the parasternal short-axis view, the apical five-chamber view (G) and the apical four-chamber view (H). AO = ascending aorta, LA = left atrium, RA = right atrium.
Table 1.
Baseline patient characteristics.
Table 2.
Results and complications at the time of the procedure and at the follow-up visit.
Table 3.
Immediate and follow-up ASD closure success rates.