Three-dimensional echo and videocardioscopy-guided atrial septal defect closure

Background. Current real-time three-dimensional echocardiography systems (RT3DE) can provide sufficient visualization to permit atrial septal defect (ASD) closure. However, detailed visualization of small objects inside the heart is still suboptimal because of limited resolution, which is a limitation for clinical application. We evaluate the complementary use of videocardioscopy in image-guided ASD closure. Methods. In a pig model (n = 5), a 4-mm to 8-mm ASD was created with RT3DE guidance. Defect closure was accomplished with a catheter-based patch-delivery system fixed around the defect with mini-anchors under combined RT3DE and videocardioscopy guidance. The endoscope was inserted into the heart through a custom built port designed to allow visualization in the presence of blood. Results. All ASDs were successfully closed. The combination of RT3DE and videocardioscopy allowed detailed visualization of intracardiac structures, instruments, patch, and mini-anchors. Conclusions. Beating-heart ASD closure can be achieved with combined RT3DE and videocardioscopy imaging. Use of videocardioscopy provides high-resolution imaging and likely improves safety of the image-guided procedure.