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Background: Transcatheter closure of atrial septal defect secundum (ASD-II) has become an alternative method for surgery. We sought to compare the two-dimensional transesophageal echocardiography (TEE) method for measuring atrial septal defect with balloon occlusive diameter (BOD) in transcatheter ASD-II closure.Methods: A total of 39 patients (71.1% female, mean age: 35.31 ± 15.37 years) who underwent successful transcatheter closure of ASD-II between November 2005 and July 2008 were enrolled in this study. Transthoracic echocardiography (TTE) and TEE were performed to select suitable cases for device closure and measure the defect size before the procedure, and BOD measurement was performed during catheterization via TEE. The final size of the selected device was usually either equal to or 1 – 2 mm larger than the BOD of the defect.Results: The mean defect size obtained by TEE and BOD was 18.50 ± 5.08 mm and 22.86 ± 4.76 mm, respectively. The mean difference between the values of ASD size obtained by TEE and BOD was 4.36 ± 2.93 mm. In comparison with BOD, TEE underestimated the defect size in 94.9%, but TEE value being equal to BOD was observed in 5.1%. There was a good linear correlation between the two measurements: BOD = 0.773 × ASD size by TEE+8.562; r2 = 67.9.1%. A negative correlation was found between TEE sizing and the difference between BOD and TEE values (r = -0.394, p value = 0.013).Conclusion: In this study, BOD was larger than ASD size obtained by two-dimensional TEE. However, TEE maximal defect sizing correlates with BOD and may provide credible information in device size selection for transcatheter ASD closure.

Background: Given the dearth of data in the existing literature on the size and morphologic variability of secundumtype atrial-septal defect (ASD-II) in adult patients, we aimed to address this issue in a series of consecutive adult patients evaluated by transesophageal echocardiography (TEE).Methods: A total of 50 patients (68.0% female) with isolated ASD-II underwent TEE for the evaluation of the defect. The morphological characteristics of the defect were evaluated, and the largest defect size was measured. The ASD rim wasdivided into 6 sectors: the superior-anterior, superior-posterior, superior, inferior-anterior, inferior-posterior, and inferior.The minimal length of the defect rims was determined.Results: Mean age at the time of evaluation was 33.62±14.48 years. Mean defect diameter in the all the study patients was 20.80±8.17 mm. Thirteen morphological variations were detected. Deficiency of one rim was detected in 14 (28%) patients,two in 16 (32%), three in 2 (4%), and four in 2 (4%). Deficiency of the superior anterior rim was found in 24% of the patients as the most frequent morphology. There was a significant correlation between the defect size and number of deficient rims (γ=0.558, P value

Background: Stroke, one of the most important causes of morbidity and mortality in the world, is of great importance in young adults (15-45 years), amongst whom the causes of stroke and transient ischemic attack (TIA) are different from those in older ages and a significant portion of them have no known etiology. Patent foramen ovale (PFO) is considered a probable cause in this group.Methods: Patients between 15 and 45 years of age with TIA or stroke were examined and evaluated for causes of cerebrovascular accidents. Patients with no definite cause for stroke or TIA, except for PFO, despite our extensive evaluations were categorized as cryptogenic. The controls were comprised of those between 15 and 45 years old who underwent transesophageal echocardiography (TEE) for reasons other than stroke. The frequency of PFO and its characteristics were compared between the two groups.Results: The case group comprised 48 patients with cryptogenic stroke (n=31) and TIA (n=17), and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between the age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25%, respectively (p value=0.003, odds ratio=3.33, confidence interval=1.46-7.63). The exaggerated motion of the interatrial septum (IAS) in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively (significant differences). The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups.Conclusion: PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of cerebrovascular accidents.

Quadricuspid aortic valve (QAV) is an uncommon congenital anomaly which was an incidental finding during surgery or autopsy in the past. We present the case of a 44-year-old woman with moderately severe aortic regurgitation due to unequal cusp size QAV diagnosed via transesophageal echocardiography. Due to echocardiographic imaging improvement, the diagnosis of QAV is now easier and earlier than the past.