Echocardiographic Evaluation of Iatrogenic Atrial Septal Defect After Catheter-Based Mitral Valve Clip Insertion

• Published in: The American journal of cardiology 2012-06, Vol.109 (12), p.1787-1791
• Main Authors: Saitoh, Takeji, MD, Izumo, Masaki, MD, Furugen, Azusa, MD, Tanaka, Jun, MD, Miyata-Fukuoka, Yoko, MD, Gurudevan, Swaminatha V., MD, Tolstrup, Kirsten, MD, Siegel, Robert J., MD, Kar, Saibal, MD, Shiota, Takahiro, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Catheterization - methods; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Catheters; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Female; Heart; Heart Septal Defects, Atrial - diagnostic imaging; Heart Septal Defects, Atrial - surgery; Humans; Iatrogenic Disease; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Mitral Valve Insufficiency - surgery; Surgical Instruments; Ultrasonic imaging; Ultrasonic investigative techniques
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.02.023

The geometries and sizes of persistent iatrogenic atrial septal defects (IASDs) after transseptal puncture during catheter-based mitral valve clip insertion (MVCI) have not been detailed. In this study, 11 IASDs were investigated in 10 patients who underwent MVCI using a guide catheter (24Fr proximally and 22Fr at the atrial septum). The diameters of the long and short axes and the area at maximum and minimum during a cardiac cycle were measured after MVCI using real-time 3-dimensional (RT3D) transesophageal echocardiography (TEE). A circular shape was assumed on 2-dimensional TEE, resulting in an area calculation of π × (dimension/2)2 . The anatomic geometries of IASDs were visualized in a 3-dimensional en face view of the atrial septum. Furthermore, 1 month after MVCI, IASDs were evaluated using echocardiography. The IASDs had a variety of irregular geometries. The mean long-axis diameter was 1.0 ± 0.24 cm, the mean short-axis diameter was 0.51 ± 0.22 cm, and the mean area was 0.40 ± 0.24 cm2 on RT3D TEE. The diameters and area changed significantly between the maximal and minimal values during the cardiac cycle. Importantly, 2-dimensional TEE underestimated the maximal diameters of IASDs (0.54 ± 0.17 vs 1.0 ± 0.24 cm by RT3D TEE, p