Key result
Device sizing based on 3D TEE parameters using a derived prediction equation yielded similar sizes to 2D TEE-based actual device sizes (24.88 vs 24.32 mm, p=0.31) for transcatheter ASD closure.
Why the study?
Although 3D TEE provides high-resolution en-face images of ASD, it is used in only a fraction of cases compared to 2D TEE for transcatheter ASD device closure assessment.
Does 3D TEE provide comparable device sizing accuracy to 2D TEE in patients undergoing transcatheter ASD closure?
Observational (n=30)
No
Does 3D TEE provide comparable device sizing accuracy to 2D TEE in patients undergoing transcatheter ASD closure?
Absolute Event Rate: 24.88% vs 24.32%
p-value: p=0.31
Device sizing based on 3D TEE parameters alone is equally effective for transcatheter ASD closure as compared to 2D TEE, potentially avoiding the need for balloon sizing.
3D TEE sizing appears comparable to 2D for ASD closure; leaves open whether routine adoption improves outcomes or safety.
BACKGROUND: Two-dimensional (2D) transesophageal echocardiography (TEE) is commonly used for assessing patients undergoing transcatheter atrial septal defect (ASD) device closure. 3D TEE, albeit providing high resolution en-face images of ASD, is used in only a fraction of cases. We aimed to perform a comparative analysis between 3D and 2D TEE assessment for ASD device planning. METHODS: This was a prospective, observational study conducted over a period of one year. Patients deemed suitable for device closure underwent 2D and 3D TEE at baseline. Defect characteristics, assessed separately in both modalities, were compared. Using regression analysis, we aimed to derive an equation for predicting device size using 3D TEE parameters. RESULTS: Thirty patients were included in the study, majority being females (83%). The mean age of the study population was 40.5 ± 12.05 years. Chest pain, dyspnea and palpitations were the common presenting complaints. All patients had suitable rims on 2D TEE. A good agreement was noted between 2D and 3D TEE for measured ASD diameters. 3D TEE showed that majority of defects were circular in shape (60%). The final device size used had high degree of correlation with 3D defect area and circumference. An equation was devised to predict device size using 3D defect area and circumference. The mean device size obtained from the equation was similar to the actual device size used in the study population (p = 0.31). CONCLUSIONS: Device sizing based on 3D TEE parameters alone is equally effective for transcatheter ASD closure as compared to 2D TEE.
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Mani et al. (2023) conducted an observational in Atrial septal defect (n=30). 3D transesophageal echocardiography (TEE) vs. 2D transesophageal echocardiography (TEE) was evaluated on Predicted device size using 3D TEE parameters vs actual device size based on 2D TEE (p=0.31). Device sizing based on 3D TEE parameters using a derived prediction equation yielded similar sizes to 2D TEE-based actual device sizes (24.88 vs 24.32 mm, p=0.31) for transcatheter ASD closure.
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