Assessment of atrial septal defect using 2D or real-time 3D transesophageal echocardiography and outcomes following transcatheter closure

Abstract

Background: The assessment of interatrial septum (IAS) requires a standardized, systematic approach, including two-dimensional transthoracic echocardiography (2D TTE), 2D transesophageal echocardiography (2D TEE), and three-dimensional (3D) TEE. Although 2D TEE has been widely used for the preoperative assessment of atrial septal defect (ASD), its ability to provide reliable information is often limited due to the structural characteristics of IAS. The introduction of 3D TEE provides a unique "en face" view of IAS, which allows the visualization and accurate measurements of diameters, area, and rims of ASD.Hence, appropriate ASD imaging information is particularly important in successful transcatheter closure.Methods: In this retrospective study, 2D TTE/TEE, and 3D TEE were performed before ASD closure, with 2D minimal and maximal diameters, areas, and residual rims being recorded. Adequate 3D TEE imaging data sets were collected and then analyzed. ASD related parameters were compared using different echocardiography. Patients who underwent ASD closure completed a clinical follow-up. Results:The mean defect maximal diameter and aperture area by 3D TEE was significantly larger than that of the corresponding 2D TEE (P<0.05). There was no statistical difference in the minimal and maximal diameter or area by TEE for circular-shaped ASDs. For oval ASDs, mean minimal diameter on 2D TEE was larger than that on 3D TEE. The mean maximal diameter measured using 2D TEE was smaller than the 3D TEE measurement (16.0±7.1 vs. 19.8±8.6; P<0.05). For complex-shaped defects, there were statistical differences in minimal and maximal diameter between TEEs. Furthermore, 2D and 3D TEE had a longer superior vena cava (SVC) residual rim than did 2D TTE (P<0.05). The 3D TEE residual rims of the inferior vena cava (IVC) was significantly larger than the corresponding 2D TEE. There was a very strong correlation between the residual rim measurements using 3D and 2D TEE. However, the limits of agreement between 2D and real-time 3D TEE measurements were more apparent in the IVC rim group than in the other groups.Conclusions: Our study confirms the value of 3D TEE in assessing ASD shape and size reported by previous studies, and is also the first to accurately and systematically characterize ASD residual rim in complex ASDs.

Đối Chiếu Kích Thước Lỗ Thông Liên Nhĩ Trên Siêu Âm 2d/3d Qua Thực Quản Với Đường Kính Eo Của Dụng Cụ Bít Lỗ Thông Liên Nhĩ Trên Thông Tim

“…Phân bố bệnh nhân theo tuổi: Tuổi BN trong nghiên cứu của chúng tôi từ 16 -69 tuổi, gặp nhiều nhất ở độ tuổi 17 -29. So với nghiên cứu của một số tác giả trong nước thì kết quả của chúng tôi tương đương [2], [10] Trong 58 bệnh nhân của nghiên cứu này, chúng tôi nhận thấy hình ảnh vách liên nhĩ với các gờ xung quanh, các cấu trúc lân cận được quan sát rất rõ trên SATQTQ 3D, kích thước lỗ thông liên nhĩ trên SATQTQ 3D và kích thước lỗ thông khi đo bằng bóng (sizing balloon) khá tương ứng với nhau và ước lượng sizing dụng cụ bít TLN trên SATQTQ 3D có giá trị chênh lệch với sizing dụng cụ (1,43±2,28mm) thấp hơn so với SATQTQ 2D (3,76±2,48mm).…”

“…SATQTQ 3D rất hữu ích hỗ trợ cho việc chọn lựa kích thước dụng cụ đóng TLN. Hình ảnh SATQTQ tốt hơn hẳn chiếu huỳnh quang do nhìn rõ các cấu trúc phía sau của tim, cung cấp nhiều thông tin về giải phẫu và về lỗ TLN hỗ trợ tốt cho chọn lựa kích thước dụng cụ bít thích hợp, góp phần rút ngắn thời gian làm thủ thuật, giảm ngắn thời gian phơi nhiễm với tia X, giúp thực hiện kỹ thuật đóng TLN an toàn và hiệu quả hơn [10].…”

Role of Echocardiography in the Diagnosis and Interventional Management of Atrial Septal Defects

“…Three-dimensional (3D) echocardiographic studies were initially developed in the early 1990s [ 28 , 29 ], as reviewed elsewhere [ 30 ]. Three-dimensional echo appears to have an advantage in accurately measuring the ASD size in complex-shaped ASDs [ 31 , 32 ]. For circular-shaped ASDs, the measurements of ASD size are similar, both by 2D and 3D echocardiography, while in oval-shaped and bizarre-shaped ASDs, the 3D measurements were larger than those secured by 2D echo.…”

“…For circular-shaped ASDs, the measurements of ASD size are similar, both by 2D and 3D echocardiography, while in oval-shaped and bizarre-shaped ASDs, the 3D measurements were larger than those secured by 2D echo. Septal rims are more clearly characterized by 3D than by 2D echo [ 31 , 32 ]. Because of the usefulness and accuracy, some centers have routinely used 3D TEE during device closure of ASDs [ 33 ].…”

The Chinese Experience of Imaging in Cardiac Intervention

“…Further, real-time 3D-TEE optimizes the spatial and temporal resolution and enables an en face view, thereby significantly enhancing the visualization of a complex 3D structure. Deng et al81 used 3D-TEE to evaluate the atrial septal defect preoperatively and accurately and systematically characterized the residual edge of the complex atrial septal defect. Compared with 2D-TEE, its detection uncertainty for thrombus is significantly reduced ( P <0.001), and it can safely, and in real-time assess the LAA morphology of patients with atrial fibrillation (AF) 82,83…”