3Dechocardiography
the art of defining cardiac morphology

Spiral ASD & Risk for device embolization

Morphological variations of the secundum atrial septal defects: 3D echocardiographic delineation a 'spiral septal defect'

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On 2D the atrial septal defect appears eminently suitable for device closure.

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Same defect on 2D on the long axis view showing good SVC margin

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Slightly more angulated view with asweep suggests a thin strand parrallal to the SVC representing part of the primum septum

Morphological variations of the secundum atrial septal defects: 3D echocardiographic delineation a 'spiral septal defect'

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Video1: 3D profile of an unusual secundum atrial septal defect.

The initial part of the video starts with a view from the left atrium showing part of the septal defect and the ascending aorta. As the image is rotated to view from the right atrial side a 'band'starts appearing in the inferior margin. The image is then further rotated to visualize the ASD profile from the LA side . Now it becomes clear that at the inferior aspect of the primum and secundum septae has not fused together leaving a significant gap in between the two septae. This anatomy is difficult to illustrate without 3D and is unsuitable for device closure due to the spacial seperation between the two aspects of the inferior margins. Any attempt to close the defect may lead to device embolization.

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3D profile of another spiral ASD is illustrated in the video above. Note the total absence of the rim bordering the aorta anteriorly. On dynamic balloon sizing, the defect measured 10mm left to right and 24mm right to left. The LA size was inadequate for the 24mm device and attempt for transcatheter closure was abandoned. Lesson: spiral ASDs are perhaps better handled by the surgeons.

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A second case of spiral ASD with an additional defect

This 3D image reveals the extra ordinary morphology of the secundum defect illustrating the wide gap between the primum and secundum component of the atrial septal defect. the inferior margin of the secundum septum is thin and has a small second defect at the infero-medial aspect. Though the 2D images are tempting and reassuring to go for a devcice closure the anatomy of the margins clearly demonstrate that this is a no go area for device closure.

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PFO tunnel in a 65 year old man presenting with cyanosis (sats 70-80%) after a fall. Treated initially with 10L/min mask oxygn and subsequently requiring ventillation and tracheostomy. Past history of pulmonary valvotomy in 1959. Echocardiogram showed residulal RVOT obstruction and predominantly right to lefting PFO. Transcarheter balloon valvuloplasty with closure of Atrial communication restored normal saturations without the need for ventillatory support.

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