ASD

ASD Defect Measures using IVUS

A 61 year-old female patient visited the hospital due to cardiomegaly which was detected on her routine healthcare examination. Electrocardiography(ECG) showed Incomplete right bundle branch block, and cardiac enzyme was normal. Transthoracic echocardiography(TTE) showed atrial septal defect (ASD), ostium secundum type. The maximal defect size was 1.5 cm on TTE. Coronary angiography showed minimal coronary artery disease. We evaluated the ASD with transesophageal echo (TEE) and  the maximal defect size was 18 mm. Cardiac catheterization was performed via right femoral vein. Standard right heart cath was performed and O2 step-up was detected at right atrium. Angiogram revealed atrial communication. Sizing balloon and 3D TEE were used to measure the defect. The defect size was 18 mm by 3D TEE (Figure 1A, Supplement video 1) and sizing balloon measured defect size was 20 mm (Figure 1B). Peripheral intravascular ultrasound (IVUS) was used to measure the defect size and compared the accuracy. IVUS measured defect size was 19.2 mm (Figure 1C, Supplement video 2A, 2B). Cocoon septal occluder(Vascular Innovations Co.) was used to (device size 22mm, LA disc 36 mm, RA disc 32 mm) occlude the defect(Figure 2). The correct placement of the device was confirmed by TEE, the device was released and delivery sheath was removed. Angiogram after the procedure revealed minimal atrial communication. 3D TEE showed successful defect closure (Figure 3, Supplement video 3).

Fig. 1. The defect size measured by 3D TEE(A), sizing balloon(B) and peripheral IVUS(C).

Figure 2. Cocoon septal occluder was used to occlude the ASD.

Figure 3. 3D TEE showed successful defect closure