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Updated: Sep 26, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transthoracic three-dimensional echocardiography prior to closure of atrial septal defects in children
Philippe Acar1, Daniel Roux, Yves Dulac
1Unité de Cardiologie Pédiatrique, Hôpital des Enfants, Toulouse, France. acar.p@chu-toulouse.fr
Insights
Transthoracic 3D echocardiography accurately measures atrial septal defects in children. This non-invasive technique aids in selecting patients for transcatheter or surgical closure.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Echocardiography
Background:
- Atrial septal defects (ASDs) are common congenital heart conditions requiring accurate pre-procedural assessment.
- Traditional echocardiography may have limitations in fully characterizing ASD morphology and rim anatomy.
Purpose of the Study:
- To evaluate the accuracy of transthoracic three-dimensional echocardiography (3D-TTE) in assessing ASD morphology before closure.
- To compare 3D-TTE measurements with findings from transcatheter and surgical interventions.
Main Methods:
- 62 children (2-18 years) with ASDs underwent 3D-TTE to measure defect diameter and rim extent.
- Measurements were compared with intraoperative findings and device measurements for transcatheter closures.
Main Results:
- 3D-TTE showed good correlation with balloon measurements for maximal ASD diameter (r=0.78).
- Excellent correlation was observed between 3D-TTE and surgical findings for rim deficiency assessment (r=0.93).
- 95% of patients undergoing transcatheter closure with Amplatzer septal occluders achieved successful closure.
Conclusions:
- 3D-TTE is accurate for measuring ASD maximal diameter and rim integrity within the oval fossa.
- This non-invasive imaging modality is valuable for guiding the selection of pediatric patients for ASD closure procedures.
Aims:
Our aims were to use transthoracic three-dimensional echocardiography to assess the morphology of atrial septal defects in children prior to closure, and to compare the three-dimensional echocardiographic data with transcatheter and surgical findings.
Methods And Results:
We used transthoracic three-dimensional echocardiography in 62 consecutive patients, aged from 2 to 18 years, with atrial septal defects, measuring the maximal diameter and the extent of the rims. Subsequent to the study, we referred 42 patients for transcatheter closure, the rims being measured at greater than 4 mm. We found a good correlation between the maximal diameter of the defect as measured at transthoracic three-dimensional echocardiography and using a balloon (y = 3.45 - 0.73x; r = 0.78; p < 0.0001), the mean difference between the measurements being 2.4 +/- 2.8 mm. Successful closure with the Amplatzer septal occluder, having a mean size of 22 +/- 4 mm, was achieved in 95% of the patients. Of the original cohort, 20 patients were referred for surgical closure. In these patients, the inferior rim had been deemed insufficient in 5, the postero-superior rim in 6, and the postero-inferior rim in 9. Complete agreement was found when the deficiency of the rim as judged using transthoracic three-dimensional echocardiography was compared with intraoperative findings. The correlation between measurements of the deficiency of the rim achieved by transthoracic three-dimensional echocardiography and at surgery was excellent (y = 0.2 + 0.98x; r = 0.93; p < 0.0001), the mean difference between the measurements being no more than 0.6 +/- 0.4 mm.
Conclusions:
Transthoracic three-dimensional echocardiography proved accurate in measuring the maximal diameter and rims of atrial septal defects within the oval fossa. This non-invasive method will be valuable in selecting children for transcatheter or surgical closure of such defects.
