%0 Journal Article
%T Echocardiographic assessment and percutaneous closure of multiple atrial septal defects
%A Andrew RJ Mitchell
%A Philip Roberts
%A Jonas Eichh£¿fer
%A Jonathan Timperley
%A Oliver JM Ormerod
%J Cardiovascular Ultrasound
%D 2004
%I BioMed Central
%R 10.1186/1476-7120-2-9
%X Atrial septal defect (ASD) closure is now commonly performed using a transcatheter, percutaneous approach and with the Amplatzer septal occluder, large defects can be safely closed [1,2]. Device deployment requires a rim of atrial septal tissue surrounding the defect to allow effective capture of the septum by the occluder. The rim of tissue is also important to separate the septal occluder from important structures including the inferior vena cava, coronary sinus and the atrioventricular valves.The majority of patients require a single device for closure of the ASD but a small proportion of patients may have more than one defect in the atrial septum. This can be difficult to diagnose using transthoracic echocardiography (TTE) as abnormal colour flow obscures the origins of the shunt, particularly if the second defect is situated inferiorly. We report three cases of patients referred for ASD closures that were found to have multiple ASDs and the techniques used to close these defects.A 34-year old woman was referred for consideration of percutaneous ASD closure. The ASD had been diagnosed when the patient was 12 years old and TTE had suggested that the right ventricle was dilating. At cardiac catheterisation there were mildly elevated right ventricular systolic pressures and a pulmonary to systemic flow ratio of over two. The secundum ASD was estimated to be 15 mm wide using TTE with aneurysmal formation of the interatrial septum. The patient was admitted for percutaneous ASD closure and underwent uncomplicated placement of a 17 mm Amplatzer septal occluder. Transesophageal echocardiography (TEE) during the procedure revealed the presence of a second ASD near the inferior vena cava and a small post-procedure shunt. The septal occluder did not completely cover both defects. Equivalent chest x-ray radiation dose (assuming a single posteroanterior projection chest x-ray is eight centi-Gray/cm2) was 400. Repeat TTE continued to demonstrate left to right shunting and the
%K Atrial septal defects
%K Amplatzer septal occluder
%K echocardiography
%U http://www.cardiovascularultrasound.com/content/2/1/9