Abstract
Transesophageal echocardiography (TEE) under general anesthesia (GA) or intracardiac echocardiography (ICE) under sedation is usually used for echocardiographic guidance during transcatheter atrial septal defect (ASD) closure. However, appropriate selection of guidance has not been fully established. Our study aimed to evaluate whether selection of guidance depending on anatomic ASD features and TEE tolerability under sedation contributes to procedure success. On the basis of anatomic ASD characteristics and TEE tolerability under sedation during the pre-procedural TEE, we selected either TEE, ICE, or combined TEE and ICE under moderate-to-deep sedation or TEE under GA for guidance. Anatomic characteristics of the defect, medical costs, complications, and primary outcomes for these four different types of guidance were analyzed. A total of 154 patients were classified into four guidance groups depending on the results of diagnostic TEE under sedation; 11 patients were scheduled for the procedure under GA in advance. Procedures were successfully completed in all but two patients in whom closure guided by TEE under sedation was attempted for an extremely large defect or extensive superior rim deficiency. Two patients who underwent TEE or combined TEE and ICE guidance under sedation were converted to ICE-only guidance due to desaturation or excessive body movement. Device dislodgement was not observed during the procedure or during median follow-up of 1188 days [interquartile range 577–1831]. Appropriate selection of guidance might contribute to successful transcatheter ASD closure.
Similar content being viewed by others
Abbreviations
- ASD:
-
Atrial septal defect
- GA:
-
General anesthesia
- ICE:
-
Intracardiac echocardiography
- TEE:
-
Transesophageal echocardiography
- USD:
-
U.S. dollar
References
Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K (2002) Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol 39(11):1836–1844
Masura J, Gavora P, Podnar T (2005) Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders. J Am Coll Cardiol 45(4):505–507
Kotowycz MA, Therrien J, Ionescu-Ittu R, Owens CG, Pilote L, Martucci G, Tchervenkov C, Marelli AJ (2013) Long-term outcomes after surgical versus transcatheter closure of atrial septal defects in adults. JACC Cardiovasc Interv 6(5):497–503
Amin Z (2006) Transcatheter closure of secundum atrial septal defects. Catheter Cardiovasc Interv 68(5):778–787
Aitkenhead AR (2005) Injuries associated with anaesthesia. A global perspective. Br J Anaesth. 95(1):95–109
The American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology (2018) Practice guidelines for moderate procedural sedation and analgesia. Anesthesiology 128(3):437–479
Doi M, Gajraj RJ, Mantzaridis H, Kenny GN (1997) Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. Br J Anaesth 78(2):180–184
Liu J, Singh H, White PF (1997) Electroencephalographic bispectral index correlates with intraoperative recall and depth of propofol-induced sedation. Anesth Analg 84(1):185–189
Vettukattil JJ, Ahmed Z, Salmon AP, Mohun T, Anderson RH (2013) Defects in the oval fossa: morphologic variations and impact on transcatheter closure. J Am Soc Echocardiogr 26(2):192–199
Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, Lang RM, Rome JJ, Wang Y, American Society of E, Society for Cardiac A, Interventions (2015) Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale: from the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 28(8):910–958
El-Said H, Hegde S, Foerster S, Hellenbrand W, Kreutzer J, Trucco SM, Holzer R, Burch G, Mirani A, Nicolas R, Porras D, Bergersen L, Moore J (2015) Device therapy for atrial septal defects in a multicenter cohort: acute outcomes and adverse events. Catheter Cardiovasc Interv 85(2):227–233
Carlson KM, Justino H, O'Brien RE, Dimas VV, Leonard GT Jr, Pignatelli RH, Mullins CE, Smith EO, Grifka RG (2005) Transcatheter atrial septal defect closure: modified balloon sizing technique to avoid overstretching the defect and oversizing the Amplatzer septal occluder. Catheter Cardiovasc Interv 66(3):390–396
Du ZD, Cao QL, Rhodes J, Heitschmidt M, Hijazi ZM (2002) Choice of device size and results of transcatheter closure of atrial septal defect using the amplatzer septal occluder. J Interv Cardiol 15(4):287–292
Pandian NG (1989) Intravascular and intracardiac ultrasound imaging. An old concept, now on the road to reality. Circulation 80(4):1091–1094
Mullen MJ, Dias BF, Walker F, Siu SC, Benson LN, McLaughlin PR (2003) Intracardiac echocardiography guided device closure of atrial septal defects. J Am Coll Cardiol 41(2):285–292
Koenig PR, Abdulla RI, Cao QL, Hijazi ZM (2003) Use of intracardiac echocardiography to guide catheter closure of atrial communications. Echocardiography 20(8):781–787
Hijazi Z, Wang Z, Cao Q, Koenig P, Waight D, Lang R (2001) Transcatheter closure of atrial septal defects and patent foramen ovale under intracardiac echocardiographic guidance: feasibility and comparison with transesophageal echocardiography. Catheter Cardiovasc Interv 52(2):194–199
Amin Z, Hijazi ZM, Bass JL, Cheatham JP, Hellenbrand WE, Kleinman CS (2004) Erosion of Amplatzer septal occluder device after closure of secundum atrial septal defects: review of registry of complications and recommendations to minimize future risk. Catheter Cardiovasc Interv 63(4):496–502
Vigna C, Inchingolo V, Giannatempo G, Pacilli MA, Di Viesti P, Fusilli S, Amico CM, Santoro T, Lanna P, Fanelli R, Simone P, Loperfido F (2008) Clinical and brain magnetic resonance imaging follow-up after percutaneous closure of patent foramen ovale in patients with cryptogenic stroke. Am J Cardiol 101(7):1051–1055
Mugge A, Daniel WG, Angermann C, Spes C, Khandheria BK, Kronzon I, Freedberg RS, Keren A, Denning K, Engberding R et al. (1995) Atrial septal aneurysm in adult patients. A multicenter study using transthoracic and transesophageal echocardiography. Circulation 91(11):2785–2792
Vigna C, Marchese N, Zanchetta M, Chessa M, Inchingolo V, Pacilli MA, Amico C, Fanelli M, Fanelli R, Loperfido F (2012) Echocardiographic guidance of percutaneous patent foramen ovale closure: head-to-head comparison of transesophageal versus rotational intracardiac echocardiography. Echocardiography 29(9):1103–1110
Bartel T, Konorza T, Arjumand J, Ebradlidze T, Eggebrecht H, Caspari G, Neudorf U, Erbel R (2003) Intracardiac echocardiography is superior to conventional monitoring for guiding device closure of interatrial communications. Circulation 107(6):795–797
Boccalandro F, Baptista E, Muench A, Carter C, Smalling RW (2004) Comparison of intracardiac echocardiography versus transesophageal echocardiography guidance for percutaneous transcatheter closure of atrial septal defect. Am J Cardiol 93(4):437–440
Bartel T, Konorza T, Barbieri V, Erbel R, Pachinger O, Muller S (2008) Single-plane balloon sizing of atrial septal defects with intracardiac echocardiography: an advantageous alternative to fluoroscopy. J Am Soc Echocardiogr 21(6):737–740
Acknowledgements
This research was not supported by grants from any funding agencies in the public, commercial, or not-for-profit sectors. We would like to express our gratitude to Kaoru Tajiri at University Hospital Kyoto Prefectural University of Medicine in Japan for her valuable advice regarding medical cost.
Author information
Authors and Affiliations
Contributions
All authors contributed to study conception and design. Methodology: MY, TY, TN; Data collection and analysis: MY, TY, TN; Writing—original draft preparation: MY; Writing—reviewing and editing: TY, TN, KZ, HS, TS, SM; All authors read and approved the final version.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Informed consent
All study subjects provided written informed consent.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Yamano, M., Yamano, T., Nakamura, T. et al. Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure. Int J Cardiovasc Imaging 36, 855–863 (2020). https://doi.org/10.1007/s10554-020-01778-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-020-01778-9