Value of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects during port-access minimally invasive cardiac surgery

ObjectiveTo determine the role and significance of transesophageal echocardiography (TEE) in the closure of atrial septal defects (ASD) during minimally invasive cardiac surgery. MethodsSeventeen patients with secundum atrial septal defect (ASD) were examined by transthoracic echocardiography (TTE) and TEE. TTE usually allowed selection of cases likely to be suitable for closure in this fashion. TEE provided indispensable informations in the selection of eligible atrial septal defects, evaluates the exact size, location and morphology of the defect. Skin incisions were made on the right anterior chest which were 2.5 ～ 3.5 cm long. A special catheter carrying Amplatzer occluder were inserted into the left atrium via ASD. Under TEE guidance, the device was released and ASD was successfully closed. ResultsThe occluder device was successfully implanted in 15 patients. The size of ASD varied from 11 to 35 mm [mean (23±6) mm] measured by TEE, upper septal rim 4 to 17 mm[mean (10±4) mm], lower septal rim 6 to 22 mm[mean (14±6) mm]. The intracardiac procedure time ranged from 10 to 45 min[(24±13) min]. They were all discharged from the hospital 3 or 4 days after the operation. ConclusionsTEE serves as an important monitoring tool during deployment of the device. It is a necessary adjunct to minimally invasive cardiac surgery. Constant echocardiographic visualisation of the device and its position relative to the atrial septum facilitates proper placement.