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Case Study: Amplatzer Atrial Septal Defect Closure Device

Percutaneous transluminal atrial septal defect closure using an Amplatzer closure device under transoesophageal echo guidance



Transoesophageal
 
 

Transoesophageal echo represents an excellent tool for viewing deep structures of the heart. The proximity of the oesophagus to the heart presents an excellent acoustic window to the atria, aortic and mitral valves and great vessels. In these images the left atrium is seen at the top of the image and the right atrium below it. The atrial septum can be clearly defined, and using a colour flow Doppler box placed over the area of interest a blue jet is observed. This indicates the passage of blood from the left atrium to the right atrium during the cardiac cycle. This jet indicates the presence of an Atrial Septal Defect (ASD).

The correct Amplatzer
 
 

The ASD is intended to be closed. It is imperative that correctly fitted Amplatzer device is placed to form a complete seal. A catheter with inflatable balloon is inserted through the ASD to ensure that a satisfactory circumference for an Amplatzer will be used. When the catheter is pulled back without the balloon slipping through the ASD, the correct Amplatzer device is then chosen.

'yoyo' like structure
 
 

The procedure continues with the device placed on the end of a catheter being released on the left atrial side of the septum. The device springs open to lay parallel with the atrial septum. Once again the catheter is pulled back to ensure correct positioning. A similar procedure is then used to deploy the right atrial side of the device. Complete deployment displays a 'yoyo' like structure. Colour flow Doppler may once again be employed to ensure that there is no residual left to right shunting through the ASD.


 

 

Animation of Amplatzer device deployment
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