Nikolay V. Vasilyev, MD, Joseph F. Martinez, DVM, Franz P

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Three-Dimensional Echo and Videocardioscopy-Guided Atrial Septal Defect Closure Nikolay V. Vasilyev, MD, Joseph F. Martinez, DVM, Franz P. Freudenthal, MD, Yoshihiro Suematsu, MD, PhD, Gerald R. Marx, MD, Pedro J. del Nido, MD The Annals of Thoracic Surgery Volume 82, Issue 4, Pages 1322-1326 (October 2006) DOI: 10.1016/j.athoracsur.2006.05.002 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The endoscopic port. The endoscope (arrow) is inserted into the inner compartment of the port, and the instrument (arrow) is inserted into the working channel. (A) Front view; (B) side view. The Annals of Thoracic Surgery 2006 82, 1322-1326DOI: (10.1016/j.athoracsur.2006.05.002) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Atrial septal defect patch closure system ex vivo. (A) The atrial septal defect patch. (Inset) Nitinol anchor with 2-mm loop and 10-mm arms. (B) The device is delivered through an introducer, and the frame expands. (C, D) The Dacron patch is attached to the atrial septum by Nitinol mini-anchors. (E) The wire is removed, and the frame is withdrawn into the introducer. (F) Final view shows repair of the defect. The Annals of Thoracic Surgery 2006 82, 1322-1326DOI: (10.1016/j.athoracsur.2006.05.002) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) A two-dimensional color Doppler image shows the created atrial septal defect. (B) A three-dimensional color Doppler image shows the top view from the right atrium. (C) Video-assisted cardioscopy image shows the rim of the defect (arrowheads). CS = coronary sinus; LA = left atrium; RA = right atrium. The Annals of Thoracic Surgery 2006 82, 1322-1326DOI: (10.1016/j.athoracsur.2006.05.002) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) A real-time three-dimensional echocardiographic image of the patch fixed around the atrial septal defect by the anchors (arrowheads). (B) Video-assisted cardioscopy image shows the deployed anchor. (C) A postmortem photograph shows the repaired atrial septal defect. RA = right atrium; W = working channel of the endoscopic port. The Annals of Thoracic Surgery 2006 82, 1322-1326DOI: (10.1016/j.athoracsur.2006.05.002) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions