Thread by @AntonioBarros_

T1/11
#Cardiotwitter #MedEd @MedTweetorials #EchoFirst
Multi-fenestrated ASD- mfASD

The prevalence of ASD is 0.88 per 1000 adults. The most common type of ASD is a secundum - a true deficiency in the region of the fossa ovalis. @iamritu @echo_stepbystep @alexsfelixecho @NMerke

T2/11 mfASD
Standardized #EchoFirst evaluation includes TTE, TEE, Doppler & 3DEcho for assessment of rims for suitability for device closure, drainage of pulmonary veins, exclusion of sinus venosus-type ASDs, etc.
pubmed.ncbi.nlm.nih.gov/26239900/

T3/11 mfASD
Clinical case: 65yo, female, referring shortness of breath.
TT #EchoFirst findings: right chambers enlargement, preserved sistolic function, QP:QS: 2,5; deficiency in the region of the fossa ovalis sugestive of complex ASD
@VLSorrellImages @GARCIAEDINSON95 @almasthela

T4/11 mfASD
TEE was ordered for best understanding of anatomy. #EchoFirst finding: multi-fenestrated ASD. @GoncalvesCortez @fljsoares @echotalk @marciomp50 @RODRIGOVISCONT1 @mlimaMD @masiqueirajr @FilipeMarra @alexandre_aby @AleJoslin @cardiopedhnn @mariovar55 @gonzaeperez

T5/11 mfASD
Transcatheter closure is possible in some cases of mfASDs, however requires careful investigation of the anatomy of the defects and their surroundings. Caveats: sometimes we need to go in slow motion or even frame by frame for a better understanding of anatomy.

T6/11 mfASD
#3DEcho can help. I start my 3D assessment identifying anatomical landmarks (MV, AV, SVC, IVC) that help us w/spatial orientation
@VDelgadoGarcia @DavidWienerMD @EGarciaSayan @purviparwani @NadeenFaza @VerwerftJan @marcelohaertel @david_le_bihan @busato_s

T7/11 mfASD
Assuming the RA perspective, we can observe a larger and more central ASD, others defects, rims and their relationships w/ surrounding structures.
@ASE360 @CASEfromASE @DICSBC @SISIACOficial @INCIC_Chile @ImagenCardiaca @imagingssc

T8/11 mfASD
3D LA perspective
@JGrapsa @KemalogluOz @fiore_corrado
@DrJenniferCo_Vu @MariaOt58481834 @MSBBrandao @alcantaramonica @AndreaDeAndra19 @IsaMathiasMD @IsaMathiasMD @maddiejane25 @Drbernardourru1 @daviddeanunes @MagdaCarvalho10 @gumd_echo @SaudJoao

T9/11 mfASD
In this patient, posteroinferior rim (towards the inferior vena cava) was considered insufficient and so TC closure was contraindicated.

Atrial septal defect closure: indications and contra-indications ncbi.nlm.nih.gov/pmc/articles/P…

T10/11 mfASDs
Other interesting references:

Transcatheter closure of multiple interatrial communications pubmed.ncbi.nlm.nih.gov/22907918/

T11/11 mfASD
Fenestrated atrial septal defect percutaneously occluded by a single device: procedural and financial considerations pubmed.ncbi.nlm.nih.gov/25135292/