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      Sizing of Atrial Septal Defects in Adults

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          Abstract

          In a retrospective study of 51 consecutive patients undergoing transcatheter closure of secundum type atrial septal defects (ASDs), we examined the reliability of transesophageal echocardiography (TEE) prior to catheterization and compared the diameter with that obtained by balloon measurement during catheterization. The TEE diameter was 16.3 ± 4.6 mm compared with 22.5 ± 6.0 mm for the stretched diameter obtained during catheterization (p < 0.001). There was no gender difference. The degree of left-to-right shunting correlated poorly with the size of the defect. We conclude that although TEE is accurate for diagnosis of an ASD, the measurement of its size to determine the size of the closure device is at best inaccurate.

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          Most cited references 9

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          Morphological study of defects of the atrial septum within the oval fossa: implications for transcatheter closure of left-to-right shunt.

          To determine the anatomical variability of the oval fossa in cases of atrial septal defect and to find out which factors might make such defects suitable or unsuitable for closure by umbrella or clamshell devices. 100 specimens with defects of the atrial septum within the oval fossa were studied, especially the position of the defects within the fossa; the area of the defect in relation to the total area of the oval fossa; the shape of the rims and flap valve of the oval fossa; and the anatomical variability in the eustachian and thebesian valves. The oval fossa was displaced to the mouth of the inferior caval vein in four cases; displaced to the mouth of superior caval vein in two cases; placed on the middle of the interatrial wall in 43; or placed slightly towards the inferior caval vein in 51. Because of their shape 29 of the hearts were considered to be unsuitable for transcatheter closure of the defect. This was because the defect was too large (16 hearts); the oval fossa was displaced to the mouth of the inferior caval vein (four hearts) or to the superior caval vein (two hearts); lacked its anterior rim (two hearts); lacked the posteroinferior rim (one heart); because a thick eustachian valve was displaced posteriorly forming a false posteroinferior rim (one heart); or because the strand of insertion of the floor of the oval fossa was too distant from the left atrial aspect (three hearts). 68 hearts appeared to be ideal candidates for transcatheter closure; 3 would probably have been suitable; but 29 were unsuitable. These morphological variations might explain why the procedure has been unsuccessful in so many cases. Patients should be screened before any attempt is made at transcatheter closure.
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            Relationship of echocardiographic, shunt flow, and angiographic size to the stretched diameter of the atrial septal defect.

             R Langhough,  P. Rao (1991)
            Stretched diameter of the atrial septal defect (ASD), measured by balloon sizing, is generally used as a guide to the selection of the size of the device utilized for transcatheter closure of the ASD. Balloon sizing is a cumbersome procedure and sometimes requires the use of very large size balloon catheters. Several methods of assessment of ASD size, namely, echographic, pulmonary-to-systemic flow ratio (Qp:Qs), and angiographic measures, were undertaken in a group of 16 patients, aged 7 months to 45 years (median, 4.5 years), who were being evaluated for transcatheter closure of ASD; the results were compared with the stretched diameter. Although the echographic size of the ASD (9.9 +/- 4.1 mm, mean +/- SD) is similar (p greater than 0.1) to the angiographic size (7.9 +/- 2.5 mm), it is much smaller (p less than 0.01) than the stretched diameter (16.1 +/- 5.3 mm). When the relationship between various measures of ASD was examined, although the Qp:Qs ratio and angiographic size have a significant (p less than 0.05) correlation with the stretched diameter (r = 0.55 and 0.54, respectively), the echo diameter has the best correlation coefficient, r = 0.82, p less than 0.001. The stretched diameter can be estimated by the equation: 1.05 x echo + 5.49 mm. It is concluded that the echographic diameter is a useful adjunct in the estimation of the stretch ASD diameter, which in turn can be used in the selection of the size of the device for transcatheter occlusion of the ASD.
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              Echocardiographic estimation of balloon-stretched diameter of secundum atrial septal defect for transcatheter occlusion.

              Stretched diameter of the atrial septal defect (ASD), determined by balloon sizing at cardiac catheterization, is commonly used to select the sizes of the devices used for transcatheter closure of the secundum ASD. We have previously evaluated the utility of pulmonary/systemic flow ratio and angiographic and echocardiographic (echo) sizes of the ASD in estimating stretched ASD diameter in a group of 16 patients and determined that echo diameter had the best correlation with stretched diameter (r = 0.82; p less than 0.001). The stretched diameter can be estimated: 1.05 x echo diameter in millimeters + 5.49. In this study we have prospectively evaluated this formula in estimating the stretched ASD diameter by two-dimensional echo measurements obtained in two (long and short-axis) subcostal views in another group of 21 patients aged 2.5 to 29 years (median 4.5 years). The echo size of the ASD was 9.7 +/- 3.0 mm, whereas the measured stretched diameter was 15.3 +/- 4.0 mm. The predicted stretched ASD diameter was calculated according to the above formula and was 15.7 +/- 3.1 mm, not significantly different (p greater than 0.1) from the measured stretched diameter. The correlation between predicted and measured stretched ASD sizes was excellent (r = 0.9; p less than 0.001). The mean squared error was 2.4. The differences between measured and predicted values were within 2 mm in all but three patients. It is concluded that stretched ASD diameter can be estimated accurately by two-dimensional subcostal echo measurements, which in turn could be used for selection of device size for occlusion of the ASD.
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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2005
                August 2005
                19 August 2005
                : 104
                : 1
                : 1-5
                Affiliations
                Sahlgrenska University Hospital/Östra, Gothenburgh, Sweden
                Article
                86045 Cardiology 2005;104:1–5
                10.1159/000086045
                15942175
                © 2005 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 4, Tables: 1, References: 16, Pages: 5
                Categories
                Noninvasive and Diagnostic Cardiology

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