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Echocardiographic considerations during deployment of the Helex Septal Occluder for closure of atrial septal defects

Published online by Cambridge University Press:  24 May 2005

Leo Lopez ,
Roque Ventura ,
Elizabeth M. Welch ,
David G. Nykanen  and
Evan M. Zahn
Leo Lopez
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
Roque Ventura
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
Elizabeth M. Welch
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
David G. Nykanen
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
Evan M. Zahn
Affiliation:
Division of Pediatric Cardiology and the Heart Station, Miami Children's Hospital, Miami, Florida, USA
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Abstract

The Helex Septal Occluder is a new device used to close atrial septal defects via interventional catheterization. In order to study the role of echocardiography during its use, and to describe the morphologic variants of defects suitable for closure with this occluder, we evaluated all patients undergoing intended closure of an atrial septal defect with the Helex occluder. A combination of transthoracic, transesophageal, three-dimensional, and intracardiac echocardiography were used before, during, and after the procedure to characterize anatomy, assess candidacy for closure, guide the device during its deployment, and evaluate results. Among the 60 candidates included in the study, 11 were excluded because of transesophageal echocardiographic and/or catheterization data obtained in the laboratory. Attempts at closure were successful in 46 patients, and unsuccessful in 3. We successfully treated four types of defects. These were defects positioned centrally within the oval fossa with appreciable rims along the entire circumference of the defect, defects with deficient or absent segments of the rim, defects with aneurysm of the primary atrial septum, and defects with multiple fenestrations. Follow-up transthoracic echocardiograms taken at a median of 7 months demonstrated no residual defects in 21, trivial residual defects in 17, and small residual defects in 8 patients. In 20 patients, three-dimensional reconstructions were used to characterize the morphology of the defect and the position of the device. Because transesophageal echocardiography was often limited by acoustic interference from the device, intracardiac echocardiography was utilized in 3 cases to overcome this limitation.

Keywords

Oval fossa defectinterventional catheterizationtransesophageal echocardiographythree-dimensional reconstructionintracardiac echocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 3 , June 2003 , pp. 290 - 298
Copyright
© 2003 Cambridge University Press

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