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Echocardiography in case selection and monitoring PFO / ASD procedures Bushra Rana Consultant Cardiologist Clinical Lead of Non-Invasive Cardiology Papworth.

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Presentation on theme: "Echocardiography in case selection and monitoring PFO / ASD procedures Bushra Rana Consultant Cardiologist Clinical Lead of Non-Invasive Cardiology Papworth."— Presentation transcript:

1 echocardiography in case selection and monitoring PFO / ASD procedures Bushra Rana Consultant Cardiologist Clinical Lead of Non-Invasive Cardiology Papworth Hospital NHS Trust, Cambridge

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3 ♥ pre-operative checklist TOE protocol detailed assessment of defect ♥ TOE during the procedure some important considerations ♥ case examples highlighting important phenotypes role of echocardiography in percutaneous atrial septum closure overview

4 complexity of anatomy… crossing defect… device sizing … device positioning… complications… role of echocardiography in percutaneous atrial septum closure overview

5 pre-operative checklist STEP 1 confirm defect is secundum type STEP 2 surgery better option? anomalous pulmonary venous drainage mitral valve pathology STEP 3 detailed assessment of defect defect size number of defects surrounding rims atrial septal aneurysm STEP 4 interference during device placement? Eustachian valve and ridge Chiari network tunnel length thickened secondary septum LA multiple openings

6 SVC IVC CS AO ASD transoesophageal echocardiography define anatomy assess suitability for device closure right atrium superior vena cava aortic root inferior vena cava coronary sinus tricuspid valve left atrium right upper pulmonary vein mitral valve Rana et al, JACC CVI 2010; 3 (7): 749-60

7 0 degrees transverse plane SVC IVC CS AO FO high mid low TOE protocol Rana et al, JACC CVI 2010; 3 (7): 749-60

8 90 degrees longitudinal plane high mid low SVC IVC AO CS FO TOE protocol Rana et al, JACC CVI 2010; 3 (7): 749-60 IVC

9 specialist views mid oesophagus 120 degrees 50 degrees TOE protocol SVC CS AO

10 surrounding rims >5mm right atrium SVC (90-120) aortic root (50) IVC (90) CS (120) TV left atrium RUPV (0 &135) MV detailed assessment of defect

11 defect size…. PK McCarthy et al Im Paed Car 2003;15:1-24 detailed assessment of defect

12 defect size…. PK McCarthy et al Im Paed Car 2003;15:1-24 detailed assessment of defect

13 number of defects…. how many holes are there? McCarthy et al Images Paediatr Cardiol 2003;15:1-24 detailed assessment of defect

14 number of defects…. how many holes are there? detailed assessment of defect McCarthy et al Images Paediatr Cardiol 2003;15:1-24

15 number of defects…. how many holes are there? detailed assessment of defect McCarthy et al Images Paediatr Cardiol 2003;15:1-24

16 detailed assessment of defect atrial septal aneurysm…mobility, margins need for over sizing to grip firm part of septum & ensure device stability

17 imaging during procedure

18 wire position LAA/PV’s balloon inflation, defect sizing LA disc deployment RA disc deployment Position check imaging during procedure working view 50 degrees

19 wire position LAA/PV’s balloon inflation, defect sizing LA disc deployment RA disc deployment Position check imaging during procedure Balloon inflation ♦ with colour Doppler ♦ when flow stops balloon stops

20 wire position LAA/PV’s balloon inflation, defect sizing LA disc deployment RA disc deployment Position check imaging during procedure Balloon inflation ♦ with colour Doppler ♦ when flow stops balloon stops ♦ at waist outer edge-outer edge

21 wire position LAA/PV’s balloon inflation, defect sizing LA disc deployment RA disc deployment Position check imaging during procedure Repeat protocol 0/50/90/120 ♦ device profile ♦ completely gripped septum ♦ abnormal flow

22 complex anatomy

23 Rana et al Euro J Echocard 2010; 11: i19–i25 enface view from left atrium

24 MV Ao RUPV

25 left atrium view complex anatomy Rana et al Euro J Echocard 2010; 11: i19–i25

26 left atrium view complex anatomy Rana et al Euro J Echocard 2010; 11: i19–i25

27 SVC IVC CS ER FO Rana et al Euro J Echocard 2010; 11: i19–i25

28 right atrium view complex anatomy Rana et al Euro J Echocard 2010; 11: i19–i25

29 complex anatomy RUPV MV Rana et al Euro J Echocard 2010; 11: i19–i25

30 complex anatomy LA view Rana et al Euro J Echocard 2010; 11: i19–i25

31 complex anatomy LA view Rana et al Euro J Echocard 2010; 11: i19–i25

32 complex anatomy LA view Rana et al Euro J Echocard 2010; 11: i19–i25

33 complex anatomy LA view Rana et al Euro J Echocard 2010; 11: i19–i25

34 defect position Rana et al Euro J Echocard 2010; 11: i19–i25

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37 defect position Rana et al Euro J Echocard 2010; 11: i19–i25

38 summary complex anatomy… crossing defect… device sizing … device positioning… complications…

39 summary complex anatomy… crossing defect… device sizing … device positioning… complications…

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41 role of echocardiography TTE ±bubble contrast detailed imaging pre-procedural intra-procedural TOEICE TOE GA patient diagnosis assessment for suitability of device closure intra-procedural guidance device sizing/position complications Rana et al, JACC CVI 2010; 3 (7): 749-60

42 detailed assessment of defect total length of atrial septum Transverse 0 0 Longitudinal 90 0 mid oesophagus view mid oesophagus view

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