Taha Fatma, Elshedoudy Sahar
Pediatric Cardiology and Congenital Heart Diseases Unit, Cardiology Department, Tanta University, Tanta, Egypt.
Echocardiography. 2019 Oct;36(10):1884-1894. doi: 10.1111/echo.14482. Epub 2019 Sep 21.
Three dimensional transesophageal echocardiography (3DTEE) is superior to two dimensional transesophageal echocardiography (2DTEE) as it provides all atrial septal information from a single view.
To evaluate 3DTEE role in analysis of atrial septal aneurysm (ASA) and in device closure guiding.
Three dimensional transesophageal echocardiography were recorded with Vivid*E9,GE system over 14 months. ASAs were classified into 4 types (A: with PFO, B: with one ASD, C: with 2 ASDs, and D: with multiple fenestrations). Each aneurysm was assessed according to its type, shape, dimensions, orientation, aneurysmal tissue, and the surrounding rims. All patients passed to transcatheter aneurysm closure.
A total of 26 patients with ASAs were assessed (7 imperforated aneurysms excluded). The remaining 19 patients' age was 12.84 ± 5.82years. Four patients had type A aneurysms, 6 had type B, 4 had type C, and 5 had type D. 3DTEE demonstrated oval aneurysms in 17 patients. The orientation was oblique in 8 patients, vertical in 7, and horizontal in 4. The ASAs dimensions were 23.5 ± 5.1, 23.2 ± 5.1, and 22.0 ± 4.0 mm for oblique, vertical, and horizontal axes. Percutaneous closure succeeded in 18 patients. Balloon sizing was used in 4 patients. Devices used were: In type A:PFO devices, in type B:ASO devices, in type C:two patients required two ASO devices in each patient and two patients required one cribriform device, and in type D:Cribriform devices used for three patients, PFO for one and ASO for one. LA, LUPV, and RUPV approaches were used. Aspirin was received for 6 months.
Three dimensional transesophageal echocardiography helps to select aneurysms suitable for transcatheter closure, select the suitable devices, and guide the transcatheter procedure.
三维经食管超声心动图（3DTEE）优于二维经食管超声心动图（2DTEE），因为它能从单一视角提供所有房间隔信息。
评估3DTEE在房间隔瘤（ASA）分析及器械封堵引导中的作用。
使用GE Vivid*E9系统在14个月内记录三维经食管超声心动图。ASA分为4型（A：合并卵圆孔未闭，B：合并一个房间隔缺损，C：合并两个房间隔缺损，D：合并多个筛孔）。根据各动脉瘤的类型、形状、尺寸、方位、瘤体组织及周边边缘进行评估。所有患者均接受经导管动脉瘤封堵术。
共评估26例ASA患者（排除7例无穿孔动脉瘤）。其余19例患者年龄为12.84±5.82岁。4例为A型动脉瘤，6例为B型，4例为C型，5例为D型。3DTEE显示17例患者为椭圆形动脉瘤。8例方位为斜位，7例为垂直位，4例为水平位。斜位、垂直位和水平位的ASA尺寸分别为23.5±5.1、23.2±5.1和22.0±4.0mm。18例患者经皮封堵成功。4例患者使用球囊测量大小。使用的器械为：A型：卵圆孔未闭封堵器；B型：房间隔缺损封堵器；C型：2例患者各需两个房间隔缺损封堵器，2例患者需一个筛孔状封堵器；D型：3例患者使用筛孔状封堵器，1例使用卵圆孔未闭封堵器，1例使用房间隔缺损封堵器。采用左心房、左上肺静脉和右上肺静脉入路。服用阿司匹林6个月。
三维经食管超声心动图有助于选择适合经导管封堵的动脉瘤，选择合适的器械，并引导经导管操作。
