A Study Of The Application Of Real-time Three-Dimensional Ultrasonic To Transcatheter Closure Of Atrial Septal Defect

Background:Atrial septal defect(ASD)is one of most common congenital heart disease. ASD Closure has been applied in clinical generally.It is very important to measure ASD size and select occluder accurately,Previously,it is practiced by transesophageal echocardiography(TEE)and balloon stretched diameter(BSD).But complication with error election of occluder has been still found.At present,Real-time three-dimensional echocardiography(RT-3DE) provide a novel technique currently in transcatheter closure of ASD.PART one Experimental study on closure of artificial atrial septal defect with real-time three dimensional echocardiographyObjectiveTo evaluate application of real—time three dimensional echocardiography (RT-3DE)on closure of the various morphous artificial atrial septal defect (ASD). MethodsTwenty various morphous artificial ASD was made with medical emulsion discu.The area,long diameter and short diameter of twenty artificial ASD were measured by digital picture,2D echocardiography and RT-3DE.Cycloidal dimension of substitution(CDS)was calculated.The waist size of occluder was measured after releasing occluder by radio-photograph.Those results measured by digital picture and radio-photograph were served as gold standards.ResultsAmong 20 of artificial ASD,there were 14 cases(70.0%)with non-round-like defects.All ASD long diameter measured by 2D echocardiography was smaller than that by digital picture,All ASD short diameter and area measured by 2D echocardiography were larger than that by digital picture,but there was no significant difference between measured value by RT-3DE and that by digital picture.In various morphous of ASD,the waist morphology of occluder still was round-like after releasing occluder.Significant correlation was existed between the CDS of ASD measured by RT-3DE and the waist diameter of released occluder measured by radio-photograph(Y =0.0828+0.97X,r=0.965,P＜0.0001).ConclusionRT-3DE can display morphous of ASD and measure long diameter and area accurately,that has been confirmed by gold standard served as digital picture and radio-photograph.CDS is an accurate parameter to instruct the selection of ASD occluder. PART two Value of transthoracic real-time three dimensional echocardiography on selecting occluder of atrial septal defectObjectiveTo evaluate clinical application of transthoracic RT-3DE on selecting occluder of ASD.MethodsASD size and its rim of thirty patients with ASD were measured by 2D transthoracic echocardiography(TTE)on various views before occlusion.ASD was reconstructed by transthoracic RT-3DE and color RT-3DE.The images were studied in multiple orientations and cross sections,including the morphology,area,longest diameter,and CDS was calculated.The waist size of occluder was measured after releasing occluder.The results were compared with those measured by two-dimensional echocardiography and by RT-3DE.ResultsAmong 30 cases of ASD,there were 22 cases(73.3%)with non-round-like defects.In various morphous of ASD,the waist morphology of occluder still was round-like after releasing occluder.There was no significant difference between waist area of occluder and measured area of ASD by RT-3DE and color RT-3DE.All ASD diameters measured by 2D TTE were smaller than the dimension of waist after releasing,ASD longest diameters measured by RT-3DE and color RT-3DE were larger than the dimension of waist after releasing,but were no significant difference with CDS.Significant correlation was existed between the CDS of ASD measured by RT-3DE and the size of selected occluder(Y=0.29+1.132X,r=0.93,P<0.0001),and the waist size of released occluder(Y=-0.160+1.063X,r=0.98,P<0.0001).Occluder was firmly fixed without falling off in all patients. ConclusionThe transthoracic RT-DE has certain values on selection of ASD occluder.