24th ASMIHA Coverage: Occluder Device Selection in patients with Atrial Septal Defect (ASD)
JAKARTA --- Managing congenital heart disease since the beginning is important to prevent complications and improve the quality of life of patients. Management of congenital heart disease require consideration from various aspects so necessary tools are needed for selecting patients with the disease.
The topic of transesophageal echocardiography (TEE) as the modality of selection for granting occluder device, for example amplatzer septal occluder (ASO) on atrial septal defect (ASD) that was delivered by Nisa Ike Rini, MD was raised. ASD, a congenital heart defect the most common, is defects in the formation of ostium secundum. Typically, ASD manifest at the beginning of the birth even though often found in decade second life. Definitive therapy for this disease is the closure of ASD operatively by using ASO.
The use of ASO on ASD need to be done selectively. Indication ASO mounting on ASD is the ASD result septal defect secundum, the amount of a single defect, a large defect size (30-38 mm), rim adequate (> 5mm), and no defect such as mitral regurgitation or mitral stenosis. TEE examination in ASD have aim to (1) determine the location and size of the defect in the septum, (2) determine the relationship septum the mitral valve, tricuspid valve, and pulmonary veins, (3) determination the boundaries of the defect, and (4) detecting presence of other cardiac defects. TEE is the technique most accurate to evaluate defects occurred in the interatrial septum sensitivity reaches 100%. "TEE is the best modality to see defects such as ASD compared with transthoracic echocardiogram, "said M. Arief, MD.
There are 6 rim that must be considered TEE examination is aorta (supero-anterior) at an angle 30-45 degree, atrioventricular (mitral / inferoanterior) at 0 degree angle, superior vena cava (SVC / supero-posterior) on 80-110 degree angle, the inferior vena cava (IVC / infero-posterior) at an angle 80-110 degree, 30-45 degree angle and posterior rim superior. ASD patient selection for ASO performed using TEE is important because not all patients with ASD require ASO, such as the cases of mitral regurgitation and stenosis requiring mitral surgery.
Modified from Media Aesculapius by KM, Edited by Su