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Appropriate device selection for transcatheter atrial septal defect closure using three-dimensional transesophageal echocardiography

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Abstract

Detail morphological evaluation for ASD is essential to achieve successful transcatheter closure. Three-dimensional transesophageal echocardiography (3D-TEE) is emerging, but few studies have comprehensively verified the usefulness of 3D-TEE. We divided 329 patients who underwent transcatheter ASD closure at our university hospital into 157 in the Conventional group evaluated with 2-dimensional transesophageal echocardiography and balloon sizing (BS), and 172 in the 3D-TEE group evaluated with 3D-TEE additionally. We assessed usefulness of 3D-TEE and consider appropriate device selection procedure. Overall, the percentage with re-sizing of device tended to be lower in the 3D-TEE group than in the Conventional group (10.1% vs 6.0%, p = 0.187). Among preprocedural modalities, the device size was mainly decided based on the BS diameter. A logistic regression analysis demonstrated that large atrial septum aneurysms (ASA) were associated with a ≥ 2 mm discrepancy of the BS diameter from the preprocedural 3D-TEE diameter (p < 0.05). Compared to the Amplatzer Septal Occluder, the differences in device size and the preprocedural ASD measurement were greater when using the Occlutech Figulla Flex II Occluder (FFII). Particularly, among the patients implanted with FFIIs, the discrepancies of the device size from the 3D-TEE measurement were greater in patients with large ASA than those with small ASA. Preprocedural 3D-TEE is useful to select the appropriate device size. Particularly, it is necessary to select a much larger device than that derived from the preprocedural 3D-TEE measurement when using FFII in patients with a septal aneurysm.

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Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

ASD:

Atrial septal defect

ASO:

Amplatzer septal occluder

BS:

Balloon sizing

FFII:

Occlutech figulla Flex II occluder

ICE:

Intracardiac echo

TEE:

Transesophageal echocardiography

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Acknowledgements

The authors thank Ms. Makiko Dan, Kumiko Abe, Yasuko Hatori, Akemi Okamoto, Makiko Kondo, Junko Shinohara, Mai Iwao, Tomoko Okazeri, Yurie Ensaka, Sachiko Matsumoto, Kazuaki Nagatsuka, and Namiki Yoshie for technical assistance. We would like to thank Editage (www.editage.com) for English language editing.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan

    Hiroki Kitakata, Hideaki Kanazawa, Kotaro Miura, Mai Kimura, Keitaro Shinada, Marjolein C. de Jongh, Jin Endo, Hikaru Tsuruta, Mitsushige Murata & Keiichi Fukuda

  2. Department of Laboratory Medicine, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan

    Yuji Itabashi & Mitsuru Murata

  3. Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands

    Marjolein C. de Jongh

  4. Department of Laboratory Medicine, Tokai University Hachioji Hospital, Tokyo, Japan

    Mitsushige Murata

  5. Department of Cardiovascular Medicine, International University of Health and Welfare, Narita, Japan

    Akio Kawamura

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  1. Hiroki Kitakata
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  2. Yuji Itabashi
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  3. Hideaki Kanazawa
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  5. Mai Kimura
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  8. Jin Endo
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  11. Akio Kawamura
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  13. Keiichi Fukuda
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Corresponding author

Correspondence to Yuji Itabashi.

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Conflict of interest

H. Kanazawa received a consulting fee from Japan Lifeline, as well as a funding grant from Abbott. The remaining authors report no relationships that could be construed as a conflict of interest, including related consultancies, shareholdings, or funding grants.

Ethical approval

The study protocol was in accordance with Helsinki 1975 declaration and was approved by the Keio University School of Medicine Ethics Committee (20160258).

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All patients provided informed consent to participate.

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Kitakata, H., Itabashi, Y., Kanazawa, H. et al. Appropriate device selection for transcatheter atrial septal defect closure using three-dimensional transesophageal echocardiography. Int J Cardiovasc Imaging 37, 1159–1168 (2021). https://doi.org/10.1007/s10554-020-02095-x

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