Objective To evaluate the value of real-time three-dimensional transesophageal echocardiography(RT-3D-TEE)in percutaneous transcatheter closure of atrial septal defect(ASD)and its follow-up.Methods 38 patients with ASD were examined by two-dimensional transthoracic echocardiography(2D-TTE)and RT-3D-TEE.The shape of ASD was evaluated,the maximum diameter and stump length of ASD were measured,and the area of atrial septal defect was measured by RT-3D-TEE.The correlation between the maximum diameter and area of defect and the size of occluder was analyzed,and the size of occluder was selected according to the results.RT-3D-TEE was used to monitor and guide the delivery and release of the occluder during the operation.The occlusion effect was evaluated immediately after operation and reexamined at 3 and 6 months after operation.Results There was no significant difference in the parameters of residual margin of inferior vena cava and aortic side,but the length of residual margin of superior vena cava detected by RT-3D-TEE was longer than that of 2D-TTE.There was a high correlation between the maximum diameter of ASD and the area of RT-3D-TEE measured by 2D-TTE and RT-3D-TEE and the size of occluder(r=0.891,0.926,0.976,P<0.05),and the correlation between the area measured by RT-3D-TEE and the size of occluder was the highest.Percutaneous transcatheter closure of atrial septal defect was successfully performed in 36 patients under the accurate guidance and monitoring of RT-3D-TEE.The effect of transcatheter closure was good immediately,3 months and 6 months after operation,and no complications were found.Conclusion RT-3D-TEE can directly and clearly display the size,shape and residual margin of ASD before ASD occlusion,which provides reliable reference data for the selection of occluder,and can guide occlusion safely and effectively.The follow-up effect is good and has important clinical application value.
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