European Heart Journal Advance Access originally published online on March 13, 2008
European Heart Journal 2008 29(18):2226; doi:10.1093/eurheartj/ehn115
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Real-time three-dimensional transoesophageal echocardiography for guidance of atrial septal defect closures
Department for Cardiology, Pulmonology, and Vascular Medicine, Medical Clinic I, University Hospital RWTH Aachen, Pauwelsstr. 30, D-52074 Aachen, Germany
* Corresponding author. Tel: +49 241 808 9301, Fax: +49 241 808 2545, Email: jbalzer{at}ukaachen.de
ASD closure in a 53 year old female with significant left-to-right shunting was performed under fluoroscopic and TEE guidance. We used a novel matrix array three-dimensional (3D) TEE probe (X7-2t, Philips Medical Systems), providing exact imaging of cardiac structures in real-time. Panel A shows a 3D image of the ASD displaying an en-face view from the left atrium. The size and shape of the defect including the rim of the interatrial septum (IAS) are displayed on-line allowing assessment of the complete circumference of the ASD. Panel B demonstrates the setting of the exchange wire, centrally passing through the ASD orthogonally, which can be depicted with only a single 3D perspective. After unfolding of the left atrial disc, spatial orientation of the device as well as distance and relation of disc size to defect size can easily be assessed (Panel C). After unfolding of the right atrial disc, exact positioning of the device has to be ensured prior to definite release. Fluoroscopy fails to delineate the relation of the device to the IAS (Panel D). Conventional 2D TEE (Panel E) demonstrates the appropriate localization of discs but only the 3D image enables to exactly visualize the correct position of the occluder and its relation to the IAS in a real-time mode (Panel F). We here show that the application of real-time 3D TEE is feasible for the guidance of percutaneous transcatheter ASD closures, highlighting advantages and the capability of the technique to increase safety, accuracy, and efficacy of the procedure
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  J. Balzer, S. van Hall, T. Rassaf, Y.-C. Boring, A. Franke, R. M. Lang, M. Kelm, and H. P. Kuhl Feasibility, safety, and efficacy of real-time three-dimensional transoesophageal echocardiography for guiding device closure of interatrial communications: initial clinical experience and impact on radiation exposure Eur J Echocardiogr, September 15, 2009; (2009) jep116v1. [Abstract] [Full Text] [PDF]
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J. Balzer, M. Kelm, and H. P. Kuhl Real-time three-dimensional transoesophageal echocardiography for guidance of non-coronary interventions in the catheter laboratory Eur J Echocardiogr, May 1, 2009; 10(3): 341 - 349. [Abstract] [Full Text] [PDF]
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