OUTCOME OF ASD CLOSURE WITH DEVICE SIZE BASED ON PRE PROCEDURE 3D TRANSTHORACIC ECHOCARDIOGRAPHY MEASUREMENTS AND ITS COMPARISON WITH 2D TRANSTHORACIC AND 2D TRANSESOPHAGEAL ECHOCARDIOGRAPHY: AN OBSERVATIONAL ANALYSIS AT A TERTIARY CARE HOSPITAL IN JAIPUR

Introduction: For safe percutaneous ASD device closure, the rims surrounding the defect should be appropriate to allow the device to firmly hang onto the atrial septum. Two-dimensional transthoracic echocardiography (2D TTE) is adequate in detecting these defects, but the images obtained can lack the detail necessary to precisely measure their size, shape, and location. Three-dimensional transthoracic echocardiography (3D TTE) provides enhanced visualization of the defect in the majority of patients. The primary objective of the study is to estimate the proportion of cases where device was deployed safely as per the device size predetermined by pre procedure 3D TTE and to compare it with current gold standard imaging modality, ie, 2D TEE. Materials & methods: This single center observational study included 45 consecutive patients diagnosed as ostium secundum ASD by transthoracic echocardiography who were referred to SMS Hospital, Jaipur from March 2018 to September 2019. Patients included in the study, were examined by 2D and 3D TTE to determine the shape of the defect and visualize the surrounding structures before catheterization. Procedure performed under 2D TEE guidance, after measurement of defect size and surrounding tissue rims in the cath lab. Follow-up using 2D TTE and 3D TTE performed 24 hrs and 3 months after the trans-catheter ASD closure. Results: Trans-catheter ASD closure and echocardiographic examinations were successfully performed for all patients. No significant difference between the sizes of different rims by the three techniques (2DTTE vs 2DTEE vs 3DTTE). The ASD size by 3D TTE ranged from 14- 33 mm with a mean of 23.27 ± 4.91 mm and the ASD size by 2D TEE ranged from 11-32 mm with a mean of 21.73 ± 4.99 mm. While ASD size by 2D TTE ranged from 12–30 mm with a mean of 20.26 ± 4.55 mm. There was statistically significant difference between the maximum ASD diameter measured by 2D/ 3D TTE and that by 2D TEE (p = 0.013), with 3D TTE showing larger ASD diameter than 2D TTE/ 2D TEE resulting in larger predetermined size for ASD device closure. The assessment of the device relation to the aortic-mitral continuity, superior vena cava (SVC) and inferior vena cava (IVC) by 2D and 3D echocardiography was done at 24 hours and three months. Seven patients had mitral regurgitation none had more than mild mitral regurgitation. After the ASD closure, two devices were close to the SVC and one device was close to the IVC. Sixteen devices were close to the MV with mild regurgitation in three of them two were newly detected and one with previous mitral regurgitation. Twelve devices were close to the aortic rim without regurgitation. There is no major complication in any patient on follow up. Conclusion: Predetermination of ASD closure device size is possible and safe with 3D TTE. 3D TTE is a safe and non-invasive strategy as compared to 2D TEE for deciding about suitability of device closure with sufficient rims. This may be useful in patients in whom TEE could not be done, especially in pediatric population.