Atrial septal defect transesophageal echocardiography

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Overview

Anatomy

Classification

Ostium Secundum Atrial Septal Defect
Ostium Primum Atrial Septal Defect
Sinus Venosus Atrial Septal Defect
Coronary Sinus
Patent Foramen Ovale
Common or Single Atrium

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

For a full discussion on the usage of echocardiography for atrial septal defect diagnosis click here.

Overview

Transesophageal echocardiography (TEE) has had a notable positive impact on both, the care and management of a patient with congenital heart disease, such as an atrial septal defect patient. TEE has been evaluated in all age groups and is determined to be safe for pediatrics and adults.

Indications

TEE is a highly recommended method of imaging modality for atrial septal defect. It can provide:

  • Precise identification of the location
  • Bettered and more precise geometry
  • Identification of:
  • Number of atrial septal defects
  • Extent of surrounding atrial septal tissue
  • Location of adjacent structures

This information allows an interventional cardiologist to determine the best method and devise for closure.[1]

TEE in atrial septal defects

  • Trans-esophageal echocardiography is the preferred diagnostic tool in atrial septal defect.
  • To accurately diagnose the different types of atrial septal defects and associated anomalies a two-dimensional imaging of the atrial septum from different views like parasternal, apical, and subcostal views.
  • A color Doppler along with TEEDoppler helps to demonstrate amount and directions of shunting.
  • Atrial septal defects in adults could be best visualized by subcostal views with deep inspiration and high right parasternal views.
  • Ideally the entire atrial septum from the orifice of the superior vena cava to the orifice of the inferior vena cava should be visualized. This helps in detecting sinus venosus defects and large secundum defects that might extends up-to that area.
  • It also helps in identifying pulmonary veins morphology that could be helpful in sinus type of atrial septal defects and assocaiated lesions.
  • In case of diagnostic dilemmas with adults with transthoracic echocardiography, TEE helps in exact localization, size of the ASD and measurement of septal rims. All these details also help in making surgical decisions.
  • The entire coronary sinus roof should be imaged to diagnose sinus atrial septal defect. A large coronary sinus orifice with evidence of atrial shunting may indicate a defect in the roof of the coronary sinus.
  • With pulmonary artery hypertension, the low velocity of the shunt flow across the coronary sinus defect may be difficult to distinguish from other low-velocity flow within the atria.

TEE in Pediatrics

Research has indicated that TEE is a considerably safe procedure in pediatric populations.

  • The reported incidence of development of complications during TEE performance is between 1-3%.
  • Caution is recommended in inserting a probe into a neonate weigh less than or equal to 3 kg.[1]

Complications

  • The most common complications include:
  • Less common complications:

Clinical Recommendations

The Task Force of the Pediatric Council of the American Society of Echocardiography recommends the following.

A preoperative transthoracic echocardiogram be performed in every patient undergoing a transesophageal echocardiogram during congenital heart surgery. The results of the TTE should be evaluated prior to the TEE. A TEE is not recommended as the only diagnostic imagining method as there are limitations that are better identified in methods such as TTE.[1]

References

  1. 1.0 1.1 1.2 Ayres NA, Miller-Hance W, Fyfe DA, Stevenson JG, Sahn DJ, Young LT; et al. (2005). "Indications and guidelines for performance of transesophageal echocardiography in the patient with pediatric acquired or congenital heart disease: report from the task force of the Pediatric Council of the American Society of Echocardiography". J Am Soc Echocardiogr. 18 (1): 91–8. doi:10.1016/j.echo.2004.11.004. PMID 15637497.

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