Three-dimensional transesophageal echocardiography of atrial septal defect device closure

Most secundum atrial septal defects (ASD) are amenable to device closure. Three- dimensional transesophageal echocardiography (3DTEE) can be used to obtain an en face view of the ASD and important surrounding structures which provides for analysis of the type, size, shape, orientation, number and position of orifices, ASD rims and important surrounding structures in a single live 3D echo view. Also, 3DTEE is ideal for monitoring the position and configuration of devices and delivery hardware using live real -time imaging techniques. In this chapter we will describe and illustrate the methods to obtain and optimize 3DTEE en face views of the ASD during device closure using 3D zoom, live 3D and 3D full volume plus iCrop modalities. The respective 3D TEE modalities, imaging protocols, advantages and limitations will be discussed. Because it is useful, accurate and fairly simple to use, we have adopted 3D TEE for routine clinical use during ASD device closure.