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.
Transthoracic and transesophagael health cardiography is the standard imaging method to detect interatrial septum deficiencies, to select patients for transcatheter closure, to guide the interatrial procedure, and to follow up the patients. So with dimensional, transesophageal echocardiography provides a more in depth information of the interatrial septum determining the size, shape, location and the number of the interatrial communications. Three dimensional echocardiography images are used for planning and guiding the treatment of interatrial communications.
Visibility assessment for transcatheter closure and deployment of the closure device are guided by this technique. Left atrial mechanical function, tightly correlates with the prognosis of cardiac disease. Advanced echocardiography techniques can further clarify the interplay between atrial function and the closure of interatrial defects.
For 2D transthoracic echocardiographic imaging. With the patient lying on the left decubitus position with the left arm placed under the head, use the subxiphoid frontal four chamber view to obtain a good actual resolution to allow measurement of the diameter of the defect along its long axis. Use the ethical four chamber view to estimate the hemodynamic consequences of the interatrial left to right shunting, including the right ventricular dilation, and the right ventricular pressure.
Then, use the parasternal short axis view to measure the aortic and posterior rib of the septal defect. For conventional volumetric and functional left atrial measurements to provide the highest frame rate per cardiac cycle without significantly decreasing spatial resolution during speckle tracking. Set the zero strain reference at the left ventricular and diastole in the 2D left atrial strain curve.
And calculate the left atrial strain values of each phase as the difference of two of these measurements. Next, perform a 2D evaluation to allow measurement of the tricuspid annular plane systolic excursion. The right ventricular fractional area change and the Doppler Tissue Imaging Sprime velocity.
To assess the right ventricle systolic function, perform 3D analysis. Obtain electrocardiographic gated full volume of 3D dataset from the apical 4-chamber view for 3D left ventricle and right ventricle volume and function measurements. Using the incremental prognostic value over 2D parameters.
Then, perform conventional 2D volumetric and functional left atrial and ventricle measurements. Including, a left ventricle diastolic function assessment using mitral inflow and annual Tissue Doppler Imaging and assess the right ventricular global longitudinal strain. After obtaining informed written consent, place there at least four hour fasted patient with removed dental fixtures in the appropriate position and apply a suitable tropical oral folugin anesthesia and intravenous sedatives.
Monitoring the echocardiogram blood pressure and oxygen saturation throughout the procedure. Use the image to define the number, size, and location of the defects. As well as the surrounding atrial septal tissue rims, and the presence of the atrial septal aneurysm.
Use conventional 2D and 3D transesophageal echocardiographic views to determine the consequence of the arterial septal defects. Mid esophageal by cable and aortic valve short axis views are the most important planes to evaluate ASD. To verify communication through the foramen Use agitated syringe contrast during the Valve cell to maneuver.
When the right atrial pressure temporarily increases the overlapping septum primum and secundum will open and the bubbles will cross the pattern foramen ovale canal from the right atrial to the left atrial within three cardiac cycles. For a 3D transesophageal echocardiographic imaging, in the mid esophageal short axis view, use the narrow angled and wide angled modes to obtain additional information on the complex and dynamic anatomy of interatrial septum and measure the size of the atrial septal defect at the atrial and diastole and systole in alphas views in either the right or left arteries. Next, use the mid esophageal by cable and short axis view to advance the guide wires through the patent foramen ovale tunnel.
And the atrial septum defect before delivering the closure device into position. Then, use fluoroscopy and transesophageal echocardiographic imaging to perform balloon sizing of the stretched diameter of the atrial septum defect. When all of the measurements have been obtained before detaching the delivery system, assess the presence of the residual shunt evaluation and use four chamber short axis and bicaval transesophageal echocardiographic views to measure the atrial septal tissue rim and the atrial roof to the closure device distances.
In this representative analysis transthoracic echocardiographic examination was used to assess the right ventricular and biatrial enlargement and pulmonary artery systolic pressures. Transesophageal echocardiographic examination was used to estimate the size and shape of the atrial septal defect using 2D and 3D methods. In this interoperative 3D zoom image, the opening in the left-sided disc of the patent foreman of our closure device in the left atrium during its approach to the interatrial septum could be observed.
Upon full deployment, the device could be observed with the interatrial septum between the left and right-sided disc as illustrated using a correctly sized intraoperative balloon via 2D imaging is essential to obtaining an accurate measurement. As in cases of floppy atrial septal, the fully stretched atrial septal defect size can be underestimated Even with 3D measurements. Cardiac MRI can still be performed after septal defect closure.
Changes in right particular function and size and assessment of residue these are the questions this method can answer. Advanced a cardiographic techniques Using speckle tracking method can be applied for sensitive volumetric and functional assessment of the atrial to evaluate potential atrial remedy link.
