Abstract: The aim of the study was to assess the powers of complex ultrasonography in different stages of endovascular closure of atrial septal defects (ASD). 31 patients 13-56 years old (mean age 23,65 ±5,2 years) with septal defects were included into the study. Ultrasound (US) monitoring performed during the procedure of endovascular closure, and as a follow-up. There were prevalence (35,4%) of the patients with central ASD with rims of 5 mm and more. Abcence of anterio-superior or aortic rim, or its deficiency, noted in 19,2% of cases. Patent foramen ovale (PFO) registered in 25,81% of patients. Incidence of multiple ASDs and ASD in aneurysm occurred to be similar and was as high as 9,67%. In 2 cases of multiple ASDs, and 2 cases of PFO, transseptal puncture was used as an approach to left atrium, for the reason of complex anatomy of the septum. After the closure, transthoracic US showed reliable decrease of the right atrium, right ventricle, and pulmonary artery (PA) size. The majority of patients (64%) showed normalization of PA pressure and left ventricle enlargement in a week after the procedure. Two-dimensional echocardiography (EchoCG) with color Doppler mapping (CDM) is the key method for ASD imaging and assessing its suitability for endovascular closure. Transesophageal EchoCG can help in verification of the ASD anatomy and refinement of the ASD rims. Ultrasound guidance during the procedure of endovascular closure allows optimal positioning of the device, immediate assessment of the homodynamic effects, and timely diagnosis of complications. Reference 1. Банкл Г. Врожденные пороки сердца икрупных сосудов. М.: Медицина, 1980; 312. 2. Белоконь Н.А., Подзолков В.П.Врожденные пороки сердца. М.: Наука, 1991; 351. 3. Kannan B.R., Francis E., Sivakumar K., AnilS.R., Kumar R.K. Transcatheter closure ofvery large (> or = 25 mm) atrial septal defectsusing the Amplatzer septal occluder. Catheter.Cardiovasc. Interv. 2003; 59 (4): 522-527. 4. Maron B.J., Bonow R.O. et al. Hyperterophic cardiomyopathy: interrelations of clinicalmanifestations, pathophysiology and therapy. New. Engl.J. Med. 1987; 316: 844-852. 5. Бокерия Л.А. Эндоваскулярная иминимально инвазивная хирургия сердца исосудов у детей. М. 1999; 226-233. 6. Дземешкевич С.Л., Синицин В.Е., КоролевС.В., Мершина Е.А., Пустовойтова Т.С.,Фролова Ю.В., Терновой С.К., АкчуринР.С. Септальные дефекты у взрослых:современная диагностика и лечебнаятактика. Грудная и сердечно-сосудистая хирургия. 2001; 2: 40-45. 7. Пурецкий М.В., Иванов А.С., Тараян М.В.,Балоян Г.М., Плотицин А.А., РодионовА.С., Аксюк М.А., Ревуненков Г.В. Опытиспользования Amplatzer septal occluderдля закрытия дефектов межпредсерднойперегородки. Хирургия. 2008; 2: 10-14. 8. Mazic U., Gavora P., Masura J. The role of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects by the Amplatzer septal occluder. Am. Heart J. 2001; 142 (3): 482-488. 9. Belkin R.N., Pollak B.D., Ruggiero M.L., et al. Comparison of esophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale. Amer. heart J. 1994; 128 (3): 520-525. 10. Droste D.W., Lakemeier S., Wichter T., Stypmann J., Dittrich R., Ritter M., Moeller M., Freund M., Ringelstein E.B. Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts. Stroke. 2002; 33 (9): 2211-2216. 11. Hofer C.K., Furrer L., Matter-Ensner S., Maloigne M., Klaghofer R., Genoni M., Zollinger A. Volumetric preload measurement by thermodilution: a comparison with transoesophageal echocardiography. Br.J. Anaesth. 2005; 94 (6): 748-755. 12. Augoustides J.G., Weiss S.J., Ochroch A.E., WeinerJ., Mancini J., Savino J.S., Cheung A.T. Analysis of the interatrial septum by transesophageal echocardiography in adult cardiac surgical patients: anatomic variants and correlation with patent foramen ovale. J. Cardiothorac. Vasc. Anesth. 2005; 19 (2): 146-149. 13. Augoustides J.G., Weiss S.J., Weiner J., Mancini J., Savino J.S., Cheung A.T.Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography inadult cardiac surgical patients.J. Cardiothorac.Vasc. Anesth. 2004; 18 (6): 725-730. 14. Carlson K.M., Justino H., O'Brien R.E.,Dimas V.V., Leonard G.T., Pignatelli R.H.,Mullins C.E., Smith E.O., Grifka R.G.Transcatheter atrial septal defect closure:modified balloon sizing technique to avoid 18.overstretching the defect and oversizing theAmplatzer septal occluder. Catheter.Cardiovasc. Interv. 2005; 66 (3): 390-396. 15. Chen C.Y., Lee C.H., Yang M.W., Chung H.T., Hsieh I.C., Ho A.C. Usefulness of transesophageal echocardiography for transcatheter closure of ostium secundum atrial septum defect with the amplatzer septal occluder. Chang. Gung. Med.J. 2005; 28 (12): 837-845. 16. Dewhirst W.E., Stragand J.J., Fleming B.M. Mallory-Weiss tear complicating intraoperative transesophageal echocardiography in a patient undergoing aortic valve replacement. Anesthesiology. 1990; 73 (4): 777-778. 17. Mehta R.H., Helmcke F., Nanda N.C., Hsiung M., Pacifico A.D., Hsu T.L. Transesophageal Doppler color flow mapping assessment of atrial septal defect. J. Am. Coll. Cardiol. 1990; 16(4): 1010-1016. 18. Radhakrishnan S., Marwah A., Shrivastava S. Non surgical closure of atrial septal defect using the Amplatzer septal occluder in children-feasibility and early results. Indian Pediatr. 2000; 37 (11): 1181-1187.
Abstract: Aim: was to estimate possibilities of two-dimensional and three-dimensional transesophageal echocardiography (TEE) in the diagnosis of atrial septal defects (ASD). Material and methods: 52 patients with atrial septal defect underwent TEE. In 32 cases - 3D TEE, 20-2D TEE. 44 patients further underwent endovascular closure of ASD, 8 underwent cardiac surgical correction of ASD with extracorporeal circulation. Results: 3D TEE allows to make more accurately and correctly measure of ASD, to determine its location, shape, and number of defects and to quantify all edges, including top, and to measure the length of the partition in three standard areas and additional-caval from lower to upper edge. Conclusions: 3D TEE gives the most correct estimation of localization, shape and size of the defect, as well as contributes the proper determination of the optimal tactics of surgical correction of the defect. References 1. Tkachev I.V., Kondrabulatova S.S., Tarasov D.S. Rol' trehmernoj jehokardiografii v predoperacionnoj ocenke defektov mezhpredserdnoj peregorodki[The role of 3D echocardiography in preoperative estimation of atrial septal defects] Patologija krovoobrashhenija i kardiohirurgija. 2014; 1:58-61 [In Russ]. 2. Klinicheskaja kardiologija: diagnostika i lechenie v treh tomah [Clinical cardiology: diagnostics and treatment in 3 volumes. Under edition of L.A. Bokeria, E.Z.Golukhov]. T 1. ( pod redakciej L.A. Bokerija., E.Z. Goluhova) M.: NCSSH im. A.N. Bakuleva RAMN. 2011; 518-52[ In Russ]. 3. Narcyssova G.P., Malahova O.Ju., Osiev A.G. Ul'trazvukovye kriterii otbora pacientov s defektom mezhpredserdnoj peregorodki na jendovaskuljarnuju korrekciju sistemoj AMPLATZER i ocenku rezul'tatov - medicinskaja tehnologija. [Ultrasound criteria for selection of patients with atrial septal defect for endovascular correction with AMPLATZER system and the evaluation of results.] Novosibirsk. 2012; 10-11 [In Russ] 4. Prakticheskaja jehokardiografija[Practical echocardiography (under edition Frank A. Flaksamph, translation from 5. Tkacheva A.V. Diagnostika i jendovaskuljarnoe zakrytie vtorichnogo defekta mezhpredserdnoj peregorodki ustrojstvom «AMPLATZER» [Diagnosis and endovascular closure of secondary atrial septal defect with «AMPLATZER» device] Avtoreferat. Diss. kand. med. nauk. M. 2008; 24 [In Russ].
