ASD, VSD, PDA echo in the Era of Cardiac

intervention

Echocardiography to Guide
Percutaneous Interventions in
Congenital Heart Disease
Amjad Kouatli M.D.
Consultant Pediatric Cardiologist
Cardiovascular Department
King Faisal Specialist Hospital & Research Centre
Jeddah, Saudi Arabia

Echocardiographic role
Establish the diagnosis
of CHD
Establish eligibility for
intervention
Support and guide
during intervention
Detect post intervention
complications

ASD closure
VSD closure
PDA closure
PDA stenting
BT shunt stenting
Stenting of RVOT
Balloon atrial septostomy

ASD, VSD, PDA echo in the Era of Cardiac

intervention

ASD
Closure

Helex

Cardio seal

Star Flex
Amplatzer

LA
waist

RA
wings

ASD Rims

Transcatheter Closure of Secundum Atrial Septal

Defects: Zahid Amin Catheterization and
Cardiovascular Interventions 68:778787 (2006)
Classification of atrial septal rims

ASD, VSD, PDA echo in the Era of Cardiac

intervention

ASD Rims TTE

0
degree

25-40
degree

90
degree

ASD, VSD, PDA echo in the Era of Cardiac

intervention

Secundum

Sinus venosus

Primum

Procedure In cath lab.

TEE or TTE support.

ASD, VSD, PDA echo in the Era of Cardiac

intervention

During the procedure and before releasing the device

No SVC, IVC, PV obstruction
No AV valve encroachments

3 D echo
Intracardiac Echo

ICE

Courtesy of Philips Medical

ASD, VSD, PDA echo in the Era of Cardiac

intervention

VSD
closure
Amplatzer

PFM coil

Waist: corresponds to devise size VSD diameter

Wings: 2.5 to 4 mm each side, Hang the v. septum
Rims: 3-4 mm of rim is needed to stabilize the devise

ASD, VSD, PDA echo in the Era of Cardiac

intervention

VSD with aortic cusp prolapse

Aortic cusp bulging

through the VSD after
perfusing plegic solution

Prolapse of Right coronary

cusp Into RVOT

Cardioplegia
cannula
Courtesy of Dr. Ahmad Jamjoom

Devise is relatively stiff and maintains its shape

Does not accommodate septal mal-allignment

Anterior deviation
of conal septum

Posterior deviation
of conal septum

ASD, VSD, PDA echo in the Era of Cardiac

intervention

Procedure
Retrograde

Antegrade

Before release
No valve encroachment
Devise straddle the septum

Tricuspid septal leaflet

encroachment

LVOT obstruction

ASD, VSD, PDA echo in the Era of Cardiac

intervention

PFM coil
Mainly for PM VSD with aneurysm

PDA Closure
Echo evaluates
PA pressure
PDA Diameter
< 2 mm coil
> 2 mm Amplatzer

Detachable coil

PFM coil

Amplatzer

ASD, VSD, PDA echo in the Era of Cardiac

intervention

PDA Amplatzer closure

PDA coil closure

Echo post intervention

Residual PDA
May lead to
hemolysis

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ASD, VSD, PDA echo in the Era of Cardiac

intervention

Residual
COA

LPA
stenosis

LV Dysfunction

PDA diameter > 3 mm

12 YO with large PDA S/P occlusion with12x10 Amplatzer device

Initial Echo
FS 37%

Same day post occlusion

FS 26%

6 weeks post occlusion

FS = 30%

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ASD, VSD, PDA echo in the Era of Cardiac

intervention

PDA
stenting

Stent before inflation

and implantation

Stent after implantation

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ASD, VSD, PDA echo in the Era of Cardiac

intervention

Emergency BT shunt Stenting

Thrombosed
BT shunt

No flow
in BT shunt

A stent over the wire is placed

Into the BT shunt

Echo shows patency of BT shunt

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ASD, VSD, PDA echo in the Era of Cardiac

intervention

RVOT stenting in TOF

RVOT stenting in TOF

Wire & stent through RVOT

Subcostal sagital view

Sub stent stenosis
Injection post stent deployment

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ASD, VSD, PDA echo in the Era of Cardiac

intervention

Deployment of second stent

into and proximal to the first stent

Balloon atrial septostomy

for transposition of Great arteries

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ASD, VSD, PDA echo in the Era of Cardiac

intervention

Procedure can be performed

at bed side with echo guidance

Rashkind septostomy balloon

Procedure in cath lab

Plan your access before

starting the procedure

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ASD, VSD, PDA echo in the Era of Cardiac

intervention

Thank You

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