First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens Medical School, 114 Vasilissis Sofias Str, Athens, Greece.
Icahn School of Medicine at Mount Sinai, NY, New York, USA.
Int J Cardiovasc Imaging. 2020 May;36(5):873-881. doi: 10.1007/s10554-020-01786-9. Epub 2020 Feb 12.
In patients undergoing percutaneous closure of secundum atrial septal defect, the device selection is decided based on three-dimensional transesophageal echocardiography (3D TEE) measurements and two-dimensional balloon stretched diameter measurements; more importantly balloon sizing. The purpose of the study was to assess whether in patients with "halo-sign", defined as increased tissue thickness at the edge of the ASD rims, there is an agreement between 3D TEE and 2D balloon stretched diameter aiming to avoidance of balloon sizing. Forty consecutive patients who underwent closure of a single, without complex anatomy ASD were included. 3D and 2D TEE datasets were acquired and analyzed offline. Planimetry was used to calculate circumference derived diameter of ASD from 3D datasets. Patients were classified according to the presence of the "halo sign" and the agreement between circumference derived diameter and balloon stretched diameter was examined. Forty consecutive patients who underwent closure of a single, without complex anatomy ASD were included. 3D and 2D TEE datasets were acquired and analyzed offline. Planimetry was used to calculate circumference derived diameter of ASD from 3D datasets. Patients were classified according to the presence of the "halo sign" and the agreement between circumference derived diameter and balloon stretched diameter was examined. Higher correlation and lower median absolute difference between 3D TEE measurements and 2D stretched balloon diameter was found in patients with "halo sign". In patients with the "halo sign" mean diameter difference was non-significant. On the contrary statistically significant difference was found in patients without the "halo sign". Significant difference was also found when comparing mean difference in the two patient groups. ASD sizing by 3D echocardiography, is accurate in patients with halo sign and it correlates well with the balloon sizing method. This study justifies further investigation concerning the reliability of 3D imaging for the selection of the ASD device size with a view to avoid balloon sizing, decrease procedural time and thus simplify the procedure.
在接受经皮房间隔缺损（ASD）闭合术的患者中，根据三维经食管超声心动图（3D TEE）测量和二维球囊拉伸直径测量来选择器械；更重要的是球囊大小。本研究旨在评估在“晕环征”患者中，3D TEE 和二维球囊拉伸直径之间是否存在一致性，以避免球囊大小。连续 40 例接受单一、无复杂解剖 ASD 闭合术的患者纳入本研究。获取并离线分析 3D 和 2D TEE 数据集。使用平面测量法从 3D 数据集中计算 ASD 的周长衍生直径。根据是否存在“晕环征”对患者进行分类，并检查周长衍生直径与球囊拉伸直径之间的一致性。连续 40 例接受单一、无复杂解剖 ASD 闭合术的患者纳入本研究。获取并离线分析 3D 和 2D TEE 数据集。使用平面测量法从 3D 数据集中计算 ASD 的周长衍生直径。根据是否存在“晕环征”对患者进行分类，并检查周长衍生直径与球囊拉伸直径之间的一致性。在存在“晕环征”的患者中，3D TEE 测量值与 2D 拉伸球囊直径之间的相关性更高，中位数绝对差异更小。在存在“晕环征”的患者中，平均直径差异无统计学意义。相反，在不存在“晕环征”的患者中，差异有统计学意义。在两组患者中，平均差异也存在统计学差异。在存在晕环征的患者中，3D 超声心动图测量 ASD 大小准确，与球囊测量方法相关性好。本研究进一步证明了 3D 成像在选择 ASD 器械尺寸方面的可靠性，以期避免球囊测量，缩短手术时间，从而简化手术。
