Lai Echo ASD

Goals:

[ ] Defect location & size

[ ] Relation to neighboring structures- MV, RV, Syst/P Vns

[ ] Measure defect margins for ?transcatheter closure

[ ] Hemodynamics

[ ] flow direction, transseptal pressure gradient- check mean gradient

[ ] check for HD load- RA, RV enlargement, diastolic septal flattening fr RV OD

[ ] RV syst P by TR jet and systolic ventric septum configuration

[ ] biventric fx

[ ] assoc lesions

Imaging

2nd ASD:

-subs best for ASD - LA and SA views

-by SCLA the 2nd ASD isn't contiguous w post RA free wall or RPVns, unlike Sinus Venosus Defect

-by SCSA the superior limbic band of FO separates a 2nd ASD fr SVC and RUPV

-Also check for RV vol OD un SCSA w RV dilation and septal flattening

-Can check a bubble study fr AP4C

-PSSA good for atrial septum- good to check for ant-post diameter of defect

-high right PS good to check FO and superior sinus venosus ASD bc it's perpendicular to them, espec if pt is put in R lateral decub position

Sinus Venosus Defects:

-SVC-type SVD- best seen fr subcostal SA and high R parasternal views

-see communication bn R upper LA corner/RUPV and SVC

-see Q fr LA to SVC to RA

-RA type of SVD- best seen fr SCLA and PSSA

-see post-inf ASD w/o a posterior margin (see post atrial free wall flush with the defect

-LA orifice of R PVns form the interatrial communication and PVns drain directly into RA

-PSSA good to see PVn drainage...

Coronary Sinus Defects

-see dilated CS os, just above IVC-RA hct

-DDx fr primum ASD bc the ant MV leaflet is intact

-check also for LSVC

-can inject agitated saline thru L arm vn on AP4C to see contrast in L upper LA corner and then in the RA... (Q fr LA to RA via CS)

TTE & TEE for Transcatheter ASD Closure

-check location, size, relation to AV vlvs, IVC/SVC, R PVns

-check margins of ASD and total septal length

-check baseline AV vlv regurgitation

-At deployment, ensure sheath well positioned, then ensure correct disc orientation against LA septal surface...