Name: echocardiographic evaluation of atrial communications before transcatheter closure
Uploaded: 2022-02-08T13:00:00
Description: Watch this Scientific Journal Video about Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure at JoVE.com

Project no. NVKP 16-1&#8211;2016-0017 (&#8217;National Heart Program&#8217;) has been implemented with the support provided by the National Research, Development, and Innovation Fund of Hungary, financed under the NVKP 16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programs of the Semmelweis University.&#160;

In the following part we describe the protocol steps of clinical and imaging evaluation of atrial communications before transcatheter closure based on international clinical guidelines. These protocols follow the guidelines of the Semmelweis University Regional and Institutional Committee of Science and Research Ethics. Informed written patient consent is needed.
1. Clinical evaluation and workflow of cryptogen stroke and PFO for transcatheter closure
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	<li>For the diagn...

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Careful patient selection for transcatheter PFO closure represents one of the most challanging steps of the clinical evaluation, as ruling out atrial fibrillation can be difficult. Several trials in the past few years have suggested greater yield with longer term monitoring to detect atrial fibrillation.18 The Cryptogenic Stroke and Underlying Atrial Fibrillation (CRYSTAL-AF) trial detected increased atrial fibrillation rate in the insertable cardiac monitor group (8,9%) compared with standard mon...

Patent Foramen Ovale (PFO) is not a true tissue deficiency of atrial septum; it is present in about 20-25% of&#160;the adult population, and in most cases it does not have any clinical significance (Figure 1). Cryptogenic stroke accounts for ~30% of ischemic strokes and is defined as a&#160;condition without an apparent cause at the early inpatient work-up. Patients under 45 years of age represent 10% of stroke burden with as much as 40% defined as cryptogenic. Secondary prevention of stroke using transcatheter closure technique remains paramount in reducing morbidity and mortality1.
Atrial septal defects (ASDs) include different lesions on different atrial septum locations, resulting in shunting. The most common form is ostium secundum ASD, usually optimal for percutan devise closure. ASDs are generally discovered during the workup of right ventricular (RV) dysfunction and/or dilatation, and rarely after a suspected paradoxical embolism or cryptogenic stroke2,3.
Transthoracic (TTE) and transesophageal (TEE) echocardiography is performed for qualitative and quantitative assessment of atrial septum deficiencies. Three dimensional (3D) TEE provides more in depth information of the interatrial septum, and it gives more precise imaging of catheters and the closure device during intraoperative guiding. Postoperative follow up evaluations with TTE should be performed at 1, 6, and 12 months after the procedure, with a subsequent evaluation every year to assess device position, residual shunts, pericardial effusion, changes in size and function of the cardiac chambers and pulmonary circulation. Further advanced echocardiography techniques using speckle tracking echocardiography may help to understand potential functional left atrial remodeling following percutaneous closure and its impact on atrial arrhythmias2.

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		<tr height="42">
			<td height="42" style="height:42px;width:219px;">TomTec Imaging workstation</td>
			<td style="width:242px;">TomTec Imaging, Unterschleissheim, Germany</td>
			<td style="width:151px;"></td>
			<td style="width:206px;">4D LALV Function analysing software</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:219px;">Ultrasound machine</td>
			<td style="width:242px;">Philips Epiq CvX</td>
			<td style="width:151px;">serial number US81881251</td>
			<td style="width:206px;">X5-1 and X7 transducers</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:219px;">Wiwe external ECG single chanel recorder</td>
			<td style="width:242px;">Sanat Metal</td>
			<td style="width:151px;">5-810-200-1611</td>
			<td style="width:206px;">external ECG single chanel recorder</td>
		</tr>
	</tbody>
</table>

echocardiographic evaluation of atrial communications before transcatheter closure

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale (PFO) detection, for patient selection for transcatheter ASD/PFO closure,&#160;for intraoperative guidance and for long-term follow-up. The size, shape, location and the number of the atrial communications schould be determined. The accuracy of PFO detection can be improved by using agitated saline together with maneuvers to transiently increase the right atrial (RA) pressure. The appearance of microbubbles in the left atrium (LA) within 3 cardiac cycles after opacification of the RA is considered positive for the presence of an intracardiac shunt. Three dimensional TEE identifies further septal fenestrations and describes the dynamic morphology of ASD/PFO and atrial septal aneurysm. Follow-up evaluations with TTE is recommended at 1, 6, and 12 months after the procedure, with a subsequent evaluation every year. Previous studies showed an increased incidence of atrial arrhythmias early after device closure. Speckle tracking analysis may help to understand functional left atrial remodeling following percutaneous closure and its impact on atrial arrhythmias.

Clinical evaluation of symptomatic, 41 years old female patient revealed ostium secundum type ASD and floppy atrial septum using TTE and TEE examination 
TTE examination showed right ventricular and biatrial enlargement with elevated pulmonary artery systolic pressure. TEE examination was used to estimate the size and shape of ASD using 2D and 3D methods. 2D, 3D native and balloon sizing TEE measurements were compared (Figure 4, Figure 5, <...

Watch this Scientific Journal Video about Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure at JoVE.com

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Transthoracic (TTE) and transesophageal (TEE) echocardiography represent the basic imaging tools for interatrial septum examination. Three dimensional (3D) TEE provides incremental information in the assessment of the interatrial septum. Further advanced echocardiography techniques using speckle tracking echocardiography are applied for sensitive volumetric and functional assessment of the heart chambers.&#160;

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale ...

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