Assessment of atrial septal defect morphology by transthoracic three dimensional echocardiography using standard grey scale and Doppler myocardial imaging techniques: comparison with magnetic resonance imaging and intraoperative findings

Abstract

Objective-To determine whether transthoracic three dimensional echocardiography is an accurate non-invasive technique for defining the morphology of atrial septal defects (ASD). Methods-In 34 patients with secundum ASD, mean (SD) age 20 (17) years (14 male, 20 female), the measurements obtained from three dimensional echocardiography were compared to those obtained from magnetic resonance imaging (MRI) or surgery. Three dimensional images were constructed to simulate the ASD view as seen by a surgeon. Measured variables were: maximum and minimum vertical and horizontal ASD dimension, and distances to inferior and superior vena cava, coronary sinus, and tricuspid valve. In each patient two ultrasound techniques were used to acquire three dimensional data: standard grey scale imaging (GSI) and Doppler myocardial imaging (DMI). Results-Good correlation was found in maximum ASD dimension (both horizontal and vertical) between three dimensional echocardiography and both MRI (GSI r = 0.96, SEE = 0.05 cm; DMI r = 0.97, SEE = 0.04 cm) and surgery (GSI r = 0.92, SEE = 0.06 cm; DMI r = 0.95, SEE = 0.06 cm). The systematic error was similar for both three dimensional techniques when compared to both MRI (GSI = 0.40 cm (27%); DMI = 0.38 cm (25%)) and surgery (GSI = 0.50 cm (29%); DMI = 0.37 cm (22%)). A significant diVerence was found in both horizontal and vertical ASD dimension changes during the cardiac cycle. This change was inversely correlated with age. These findings were consistent for both DMI and GSI technique. In children (age < 17 years), the feasibility of detecting structures and undertaking measurements was similar for both echo techniques. However, in adult ASD patients (age > 18 years) this feasibility was higher for DMI than for GSI. Conclusions-Transthoracic three dimensional imaging using both GSI and DMI accurately displayed the varying morphology, dimensions, and spatial relations of ASD. However, DMI was a more eVective technique than GSI in describing ASD morphology in adults.

Influence of atrial septal defect anatomy in patient selection and assessment of closure with the Cardioseal device. A three-dimensional transoesophageal echocardiographic reconstruction

“…It gives a stretched diameter but our study clearly showed a very poor correlation between the stretched diameter and the threedimensional echocardiography maximal diameter, particularly in atrial septal defects of complex shapes: balloon measurement overestimates the size of round defects by stretching the septum tissue and underestimates the size of multiple defects by measuring only one hole. Furthermore, two-dimensional transoesophageal echocardiography is currently used to assess the (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) 2DE=rim surrounding the atrial septal defect obtained by two-dimensional transoesophageal echocardiography; 3DE=measurements obtained by three-dimensional echocardiography; Mean diff=mean difference between the two methods; AS=antero-superior rim; PS=postero-superior rim; AI=antero-inferior rim; PI=postero-inferior rim.…”

“…Three-dimensional echocardiography provides unique 'en face' views of intracardiac structures such as the mitral valve and the atrial septum [8][9][10][11] . Previous studies have shown the feasability of three-dimensional echocardiography reconstructions of atrial septal defects [12,13] .…”

Echocardiographic Assessment of Percutaneous Patent Foramen Ovale and Atrial Septal Defect Closure Complications

“…13,14 3D provides unique views of the interatrial septum and allows en-face views of the ASD. These views clearly define the morphology of the defect, as it has been shown to change during the cardiac cycle, 15 and its relation to contiguous cardiac structures thereby providing details which cannot be attained as easily by any other imaging technique ( Figure 2 major implications in the selection of patients for device closure. The use of 2D biplane imaging, a feature of commercially available 3D imaging transducers and software, is a complementary and sometimes sufficient option to the use of 3D imaging ( Figure 3).…”

3-D-Echokardiographie: neue Entwicklungen und Zukunftsperspektiven

“…Gerade die Einschätzung des Randsaums ist jedoch für die Auswahl des Devices und die generelle Entscheidung zum Device-Verschluss von großer Bedeutung. Die 3-D-Echokardiographie konnte somit diagnostische Lücken, die häufig nach konventioneller echokardiographischer Beurteilung verbleiben, schließen (Abbildungen 7a bis 7d) [36,37]. Darüber hinaus ist die Methode geeignet, das Ergebnis nach erfolgter Implantation eines Verschlusssystems zu kontrollieren.…”