Iranian Heart Journal

Iranian Heart Journal

Comparison Between 2D Transthoracic Echocardiography, Transesophageal Echocardiography, and Balloon Sizing Methods for Device Size Selection in Pediatric Patients Undergoing Transcatheter Closure of Atrial Septal Defects

Document Type : Original Article

Authors
Ahmad Vesal 1
Maryam Moradian 1
Mohsen Ghasemnezhad 1
Avisa Tabib 2
Fariba Rashidi Ghader 1
Seyyed Mahmoud Meraji 1
Farshad Jafari 1
Hamid Reza Ghaemi 1
Solmaz Heidari 3
Shahriar Barouti 1
Shooka Mohammadi 1
1 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
3 Department of Pediatrics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran.
Abstract
Background: Transcatheter closure of atrial septal defects (ASDs) is considered an alternative technique to surgery, and appropriate device size selection is essential to an effective procedure. We aimed to compare 2D transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), and balloon sizing methods for device size selection in pediatric patients undergoing ASD transcatheter closure and to establish an accurate and simple procedure for device size selection.
 
Methods: This cross-sectional study was performed on pediatric patients for 8 months in Tehran, Iran. Device size was identified by balloon sizing, 2D TEE, and TTE.
 
Results: This study enrolled 39 children (64.1% female, average age= 7.1±3.1 y) who underwent successful ASD transcatheter closure. The mean defect size by balloon-stretched diameter measurement was significantly greater than the ASD size measured by 2D TEE and TTE. There was a strong, highly significant positive correlation (P<0.001) between the device waist size and different ASD diameters measured by 2D TEE, TTE, and balloon sizing. A good linear association was found between the ASD size measured by device waist size and 2D TEE (device waist size= 0.99×TEE-derived defect size+1.678; P<0.001) as well as TTE (device waist size= 1.01×TTE-derived defect size+1.17; P<0.001), respectively.
 
Conclusions: In this study, TEE and TTE-derived defect sizes were significantly associated with the device waist size. Additionally, the equations generated herein may provide a reliable and good prediction for appropriate device size. (Iranian Heart Journal 2022; 23(1): 74-84)
Keywords
ASD
TTE
TEE
Children
Iran
  1. Bruneau BG. The developmental genetics of congenital heart disease. Nature 2008; 451:943-948.
  2. Dolk H, Loane M, Garne E. a European Surveillance of Congenital Anomalies (EUROCAT) Working Group. Congenital heart defects in Europe: prevalence and perinatal mortality, 2000 to 2005. Circulation 2011; 123:841-849.
  3. van der Linde D, Konings EE, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJ, Roos-Hesselink JW. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. Journal of the American College of Cardiology 2011; 58:2241-2247.
  4. Siabani H, Siabani S, Gholizadeh L. Epidemiology of Congenital Heart Defects in Iran: A Systematic Review. Online Journal of Cardiology Research & Reports 2019.
  5. Hoffman JI, Kaplan S. The incidence of congenital heart disease. Journal of the American college of cardiology 2002; 39:1890-1900.
  6. Chessa M, Carminati M, Butera G, Bini RM, Drago M, Rosti L, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. Journal of the American College of Cardiology 2002; 39:1061-1065.
  7. Xuan Tuan H, Duy Kien V, Le Cuong M, Van Son N, Dalla-Pozza R. Trends in the Prevalence of Atrial Septal Defect and Its Associated Factors among Congenital Heart Disease Patients in Vietnam. Journal of Cardiovascular Development and Disease 2020; 7:2.
  8. Rudolph A. Congenital diseases of the heart: clinical-physiological considerations. Third Edition. United States: Wiley-Blackwell, 2009.
  9. Wang JK, Tsai SK, Wu MH, Lin MT, Lue HC. Short-and intermediate-term results of transcatheter closure of atrial septal defect with the Amplatzer Septal Occluder. American heart journal 2004; 148:511-517.
  10. Gupta SK, Sivasankaran S, Bijulal S, Tharakan JM, Harikrishnan S, Ajit KV. Trans-catheter closure of atrial septal defect: balloon sizing or no balloon sizing–single centre experience. Annals of pediatric cardiology 2011; 4:28.
  11. Jang JY, Heo R, Cho MS, Bae J, Hong JA, Lee S, Ahn JM, Park DW, Kim DH, Kang DH, Song JK. Efficacy of 3D transoesophageal echocardiography for transcatheter device closure of atrial septal defect without balloon sizing. European Heart Journal-Cardiovascular Imaging 2018; 19:684-689.
  12. Zhu W, Cao QL, Rhodes J, Hijazi ZM. Measurement of atrial septal defect size: a comparative study between three-dimensional transesophageal echocardiography and the standard balloon sizing methods. Pediatric cardiology 2000; 21:465-469.
  13. Harper RW, Mottram PM, McGaw DJ. Closure of secundum atrial septal defects with the Amplatzer septal occluder device: techniques and problems. Catheterization and cardiovascular interventions 2002; 57:508-524.
  14. Harikrishnan S, Narayanan NK, Sivasubramonian S. Sizing balloon-induced tear of the atrial septum. Journal of Invasive Cardiology 2005; 17:546-547.
  15. Divekar A, Gaamangwe T, Shaikh N, Raabe M, Ducas J. Cardiac perforation after device closure of atrial septal defects with the Amplatzer septal occluder. Journal of the American College of Cardiology 2005; 45:1213-1218.
  16. Tseng HC, Hsiao PN, Lin YH, Wang JK, Tsai SK. • Transesophageal Echocardiographic Monitoring for Transcatheter Closure of Atrial Septal Defect. Journal of the Formosan Medical Association. 2000; 99:684-688.
  17. Carcagnì A, Presbitero P. New echocardiographic diameter for Amplatzer sizing in adult patients with secundum atrial septal defect: preliminary results. Catheterization and cardiovascular interventions 2004; 62:409-414.
  18. Chen FL, Hsiung MC, Hsieh KS, Li YC, Chou MC. Real time three-dimensional transthoracic echocardiography for guiding Amplatzer septal occluder device deployment in patients with atrial septal defect. Echocardiography 2006; 23:763-770.
  19. Pacileo G, Di Salvo G, Limongelli G, Miele T, Calabrò R. Echocardiography in congenital heart disease: usefulness, limits and new techniques. Journal of cardiovascular medicine. 2007; 8:17-22.
  20. Hage FG, Raslan S, Dean P, Nanda NC. Real time three‐dimensional transthoracic echocardiography in congenital heart disease. Echocardiography 2012; 29:220-231.
  21. Zanchetta M. On-line intracardiac echocardiography alone for Amplatzer Septal Occluder selection and device deployment in adult patients with atrial septal defect. International journal of cardiology 2004; 95:61-68.
  22. Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, et al. 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. Journal of the American Society of Echocardiography. 2015; 28:910-958.
  23. Esmaeili H, Vahidshahi K, Moradian M, Mortezaeian H. Change of “Left atrium ejection force” after transcatheter “Atrial septal defect” closure using “AMPLATZER,” in pediatric patients. Research in Cardiovascular Medicine 2018; 7:187.
  24. Ghaderian M, Merajie M, Mortezaeian H, Aarabi M, Mohammad Y, Mohammadi AS. Efficacy and safety of using amplatzer ductal occluder for transcatheter closure of perimembranous ventricular septal defect in pediatrics. Iranian Journal of Pediatrics 2015; 25.
  25. Ghaderian M, Merajie M, Mortezaeian H, Moghadam MY, Mohammadi AS. Mid-term follow-up of the Transcatheter closure of Perimembranous ventricular septal defects in children using the Amplatzer. The Journal of Tehran University Heart Center 2015; 10:182.
  26. Mortezaeian H, Zanjani KS, Rad EM. Transcatheter atrial septal defect closure using Occlutech Figulla device: A two-center experience. The Journal of Tehran University Heart Center 2013; 8:197.
  27. Levi DS, Moore JW. Embolization and retrieval of the Amplatzer septal occluder. Catheterization and cardiovascular interventions 2004; 61:543-7.
  28. Zanchetta M, Onorato E, Rigatelli G, Pedon L, Zennaro M, Carrozza A, Maiolino P. Intracardiac echocardiography-guided transcatheter closure of secundum atrial septal defect: a new efficient device selection method. Journal of the American College of Cardiology 2003; 42:1677-1682.
  29. Carlson KM, Justino H, O'Brien RE, Dimas VV, Leonard Jr GT, Pignatelli RH, et al. Transcatheter atrial septal defect closure: modified balloon sizing technique to avoid overstretching the defect and oversizing the Amplatzer septal occluder. Catheterization and cardiovascular interventions 2005; 66:390-396.
  30. Amin Z, Danford DA. Balloon sizing is not necessary for closure of secundum atrial septal defects. Journal of the American College of Cardiology 2005; 45:317.
  31. Hajizeinali A, Alidoosti M, Sadeghian H, Zoroufian A, Rezvanfard M, Volman MA. A comparison between size of the occluder device and two-dimensional transoesophageal echocardiographic sizing of the ostium secundum atrial septal defect. Cardiovascular journal of Africa 2013; 24:161-164.
  32. Sadeghian H, Hajizeinali A, Eslami B, Lotfi-Tokaldany M, Sheikhfathollahi M, Sahebjam M, Hakki E, et al. Measurement of atrial septal defect size: a comparative study between transesophageal echocardiography and balloon occlusive diameter method. The Journal of Tehran Heart Center. 2010; 5:74-77.
  33. Helgason H, Johansson M, Söderberg B, Eriksson P. Sizing of atrial septal defects in adults. Cardiology 2005; 104:1-5.
  34. Mesihović-Dinarević S, Begić Z, Halimić M, Kadić A, Gojak R. Reliability of transthoracic and transesophageal echocardiography in predicting the size of atrial septal defect. Acta Medica Academica. 2012; 41:145-153.
Iranian Heart Journal
Volume 23, Issue 1
Winter 2022
Pages 74-84