Pre-procedural planning for percutaneous atrial septal defect closure: Transesophageal echocardiography compared with cardiac computed tomographic angiography

Background

The safety and efficacy of percutaneous closure of atrial septal defects (ASDs) is determined by several variables, including defect size, presence of adequate rim tissue, relationship to other cardiac structures, and associated congenital anomalies.

Objective

We sought to determine the accuracy of computed tomographic angiography (CTA) in predicting a defect’s size compared with pre-procedural transesophageal echocardiography (TEE) and to the current “gold standard” balloon sizing by intracardiac echocardiography (ICE).

Methods

Thirty-five consecutive patients referred for possible percutaneous closure of suspected secundum ASD were evaluated with gated multislice CTA after initial TEE screening. Axial and sagittal image planes of the ASD from the CTA multiplanar reformation (MPR) images were used to measure the defect size and surface area.

Results

Of the 35 patients with secundum-type ASDs, 5 subjects had disqualifying anatomy by CTA and 2 had an unsuccessful closure, resulting in a procedural success rate of 93%. Measurement of defect area by gated MPR images provided the strongest correlate to ICE balloon size. In large ASDs, TEE was less well correlated to the maximum defect size and identification of the inferior/inferoposterior rims than CTA.

Conclusions

Cardiac CTA is an accurate and useful technique for pre-procedural assessment of ASDs and may be superior to conventional TEE in large defects that have deficient inferior rims.

Keywords: Atrial septal defect (ASD), Atrial septal occluder (ASO), Computed tomographic angiography (CTA), Intracardiac echocardiography (ICE), Transesophageal echocardiography (TEE)