P6103Atrial septal defect perimeter as a valuable alternative to balloon-sizing technique in the interventional approach

Introduction: When technically feasible, device closure is the treatment of choice for ostium secundum atrial septal defect (ASD). Appropriate selection of the device is a crucial step in this procedure. Periprocedural balloon-sizing (BS) of the defect guided with two-dimensional transoesophageal echocardiography (2D TEE) remains “golden standard” in the process of occluder selection. Three-dimensional (3D) image acquisition has recently emerged as a powerful tool enabling the ASD morphology to be visualised accurately, however, experience in the quantitative assessment of the defect using 3D TEE alone is still limited. Purpose: In this study we aimed to determine whether 3D TEE-derived ASD perimeter may replace traditional BS assessment of the defect. Methods: We enrolled 49 consecutive adults who underwent a successful transcatheter closure of a single, haemodynamically significant ASD in our institution between 2014–2016. Occluder size was selected based on the periprocedural BS of the defect: the balloon was placed in the atrial septum with 2D TEE guidance and gradually inflated until complete cessation of flow was observed in colour Doppler. Stop-flow diameter determined the size of the implanted occluder. For the purpose of the study, 3D images were acquired before each procedure and retrospectively analysed by 2 independent observers. The interventionist remained blind to the 3D measurements when selecting the size of the device. ASD perimeter was manually traced in the multi-planar en-face view reconstruction and compared with the size of the implant. A routine follow-up was carried out in all patients at our site.