The Role of Trans-Oesophageal Echocardiography in the Interventional Cardiology of Adult Congenital Heart Diseases

Figures

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  Figure 1. Two-dimensional TOE. Mid-oesophageal view. Extracardiac mass (pseudo-aneurysm, probably) (#) with “ab-extriseco” right atrial compression.

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  Figure 2. Periorificial rim assessment. Anterior-superior and posterior rims (A) are evaluated in 45° mid−oesophageal view (B), anterior−inferior and posterior rims (C) in 0° mid−oesophageal view (D), and posterior−superior and posterior−inferior rims (E) in 90° mid−oesophageal view (F). Abbreviations: Ao, aorta; ASD-OS, atrial septal defect ostium secundum; IVC, inferior vena cava; RV, right ventricle; SVC, superior vena cava.

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  Figure 3. Two−dimensional TOE. Mid−oesophageal view. ASD with “octopus shape” [arrow] due to an associated double interatrial septum (right-side septum [*] and left-side septum [**]).

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  Figure 4. Three−dimensional TOE view of a circular-shape ASD (A), an oval−shape one (B), an irregular−shape (like a tennis racket) one (C), and a large ASD with an internal seeding (#) (D).

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  Figure 5. Two−dimensional TOE. Mid−oesophageal view highlights a large 17 mm ASD (A) with multiple accessory fenestration (B). A single occluder device was able to have complete closure of every interatrial shunt (C,D).

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  Figure 6. Two−dimensional TOE. Mid-oesophageal view of a hypermobile interatrial septum with a single ASD (A) and an aneurysmatic interatrial septum (base width 15 mm) with multiple interatrial shunts (B).

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  Figure 7. Graphic scheme of no-aneurysmatic ASD (#) (A) and different types of aneurysmatic interatrial septum: type 1R (B), type 2L (C), type 3RL (D), type 4LR (E), and type 5 (F). Abbreviations: LA, left atrium; LV, left ventricle; MV, mitral valve; RA, right atrium; RV, right ventricle; TV, tricuspid valve.

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  Figure 8. Two-dimensional TOE. Mid-oesophageal view of a central ASD with a poor floppy posterior rim (*) and a well-represented anterior-superior rim (#). The septal malalignment may be highlighted extending the plane passing through the posterior rim (dotted red line) and measuring the distance of the latter from the anterior-superior rim (double arrow blue line).

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  Figure 9. Two−dimensional TOE. Mid-oesophageal view of a double interatrial septum (i.e., spiraliform septum). The distance (red double arrow) between the right septum (*) and the left one (**) defines the width of the double septum.

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  Figure 10. Two−dimensional TOE. Mid−oesophageal view of the following: an optimal static balloon interrogation without residual shunt (A), a residual shunt due to three accessory fenestrations (*) during a static balloon interrogation (B), a residual shunt due to under-inflation of the balloon (#) due to dynamic balloon sizing (C), a large ASD with internal seeding with a large residual shunt (arrow) due to the lack of seeding rupture during static balloon sizing (D).

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  Figure 11. Three-dimensional TOE. Left atrial view of two occluder devices in partial overlap.

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  Figure 12. Two−dimensional TOE. Mid−oesophageal view of a partial prolapse of the left disc of the device (d) with mild residual shunt (arrow) (A) and complete prolapse of the device (d) in the right atrium (B) during “push−and−pull” maneuver. In both cases, the device was substituted witha larger one.