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Figure 11. RA angiogram provides considerable
information about device position and
freedom from surrounding structures.
Using a balloon sizing catheter over
an extra stiff exchange wire and color
stop-flow technique, the defect was
sized at 13.5-14 mm (Figure 7).
A 30 mm GORE ® HELEX Septal Occluder
(device : defect diameter ratio = 2.2)
was implanted by standard techniques,
and follow-up ICE imaging showed the
inferior portion of the right atrial disc
to be slightly separated from the atrial
septum. It actually appeared caught on
the Eustachian valve (Figure 8), so a
5F multipurpose catheter was used to
gently push on the right atrial side of
the disc, freeing up the disc from the
Eustachian valve. Consequently, the
device had a flatter profile (Figures 9
and 10, before and after).
A right atrial angiogram was performed
by hand through the long delivery
sheath, showing the contrast
enveloping the right atrial disc, as well
as reflux of contrast into the SVC and
coronary sinus (Figure 11).
This provided reassurance that the
device does not impede important flow
within the heart.
Intracardiac echocardiography provides
detailed images of the heart, especially
the atrial septum. The ability to
clearly see the posteroinferior rims
of an ASD provides an advantage
over transesophageal echo, which
often results in suboptimal near-field
imaging. In addition, the use of ICE
precludes the need for endotracheal
intubation in older patients or adults,
thereby simplifying the procedure.
Please refer to GORE ® HELEX Septal Occluder
Instructions for Use at goremedical.com for
a complete description of all indications,
contraindications, warnings, precautions and
adverse events.