Multi-Fenestrated ASD

3D visualization of the atrial septum gives better understanding of the atrial morphology and planning of interventional closure of multiple atrial septal defects. While 2D echocardiographic imaging remains the mainstay of imaging of atrial septal defects in many centres, we now routinelu use RT3DE for all intra cardiac interventions. This has reduced the need for balloon sizing of defects and better interventional management.

 

Images from a patient with 2 ASDs: The 2D colour Doppler images on the left side shows a fenestrated atrial septum. The true nature or dimensions of the defect is rather elusive to the 2D. However, the 3D image on the right illustrates the true size and morphology of the defects.

 

Fig:1 An Amplatzer ASD device is positioned in D1 (defect 1) still attached to the delivery system. A delivery catheter can be seen in position in D2 for deployment of a second device. Due to the oval shape of the defect, it was felt that the second defect will not be ocluded completely by a second device. However, as the patient had elevated LA presures (16mm) it was felt desirable to have a fenestration / residual defect.

Fig 2: This image illustrates the second device in position with a small residual shunt which will enable decompression of the LA.