Author + information
- Sagit Ben Zekry, MD⁎,
- Sasidhar Guthikonda, MD, MPH, FACC†,
- Stephen H. Little, MD, FACC⁎,
- Sherif F. Nagueh, MD, FACC⁎,
- Kathleen M. Garcia, BS, RDCS, RVT⁎ and
- William A. Zoghbi, MD, FACC⁎,⁎ ()
Dr. William A. Zoghbi, Director, Cardiovascular Imaging Institute, The Methodist DeBakey Heart and Vascular Center, 6565 Fannin Street, SM 677, Houston, Texas 77030.
ATRIAL SEPTAL DEFECT (ASD) is a common congenital lesion in adults. Prolonged left-to-right shunting and excessive pulmonary blood flow may lead to pulmonary hypertension, Eisenmenger's syndrome, and right heart failure. A significant ASD should be closed irrespective of age.
Surgical closure of ASD had long been considered the definitive treatment (1,2), although percutaneous closure is now considered the treatment of choice. The main advantages of the percutaneous approach, besides the avoidance of surgery, include a high sealing rate (97% to 99%) of the defect, along with short times of procedure and hospital length of stay for the patient (3). The most frequently implanted devices consist of fabric mesh covering opposable double discs (Amplatzer, AGA Medical Corporation, Plymouth, Minnesota), a helix spiral occluder (Helex, W. L. Gore & Associates, Inc., Flagstaff, Arizona), or 2 square umbrella-like spring frames (STARFlex, Inc., NMT Medical, Boston, Massachusetts). Acute complications are rare but may include tears of the atrial septum from the sizing balloon, device embolization or entrapment, stroke, and cardiac tamponade.
The following images (fluoroscopy, 2-dimensional transesophageal echocardiogram and live 3-dimensional transesophageal echocardiogram) demonstrate a successful procedure (Fig. 1) with favorable anatomical criteria such as good septal margins and orientation of the septum and atria and an unsuccessful procedure (Fig. 2) due to a thin septum and very enlarged atria. The importance of imaging in guiding the procedure and determining the final outcome is highlighted.
- American College of Cardiology Foundation