Transesophageal echocardiography is superior to transthoracic echocardiography in the diagnosis of sinus venosus atrial septal defect

Abstract

The purpose of this study was to compare transthoracic and transesophageal echocardiography in the diagnosis of various types of atrial septal defects. Forty-one adult patients with the clinical diagnosis of atrial septal defect were studied by transthoracic and transesophageal echocardiography (30 women, 11 men; 18 to 81 years of age). Transthoracic echocardiography demonstrated the atrial septal defect in 33 patients (secundum type in 28, primum type in 3 and sinus venosus type in 2). Transesophageal echocardiography demonstrated the defect in all 41 patients. Thus, in 8 (20%) of 41 patients the atrial septal defect was demonstrated by transesophageal and not by transthoracic echocardiography. Six of the eight had a sinus venosus type atrial septal defect; the other two patients had a secundum atrial septal defect (one of these two had a technically poor transthoracic echocardiogram and the other had a small atrial septal defect). Transthoracic echocardiography, therefore, failed to demonstrate the sinus venosus defect in six (75%) of eight patients. An anomalous venous connection associated with the sinus venosus defect was visualized by transesophageal echocardiography in seven of the eight patients but was not seen on transthoracic echocardiography in any patient. Sinus venosus type atrial septal defects are frequently not visualized in adults by conventional transthoracic echocardiography. Transesophageal echocardiography is recommended when an atrial septal defect is clinically suspected but cannot be visualized by transthoracic echocardiography.

Congenital Heart Disease in the Older Adult

“…Systemic and pulmonary venous connections can often be established. It is the echocardiographic procedure of choice for identification of sinus venosus ASDs, which are visible by transthoracic imaging in only 25% of cases, 319 and for identification of anomalous pulmonary venous connections associated with this defect or in isolation. 320 Use of intraoperative TEE is considered standard of care in the surgical repair or palliation of congenital heart conditions.…”

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…Because of its superior location, the superior sinus venosus defect is most often missed by TTE (248). Patients with an unexplained RV volume overload by TTE should be studied by TEE or another imaging modality to fully evaluate the atrial septum and pulmonary veins and to rule out defects in the roof of the coronary sinus.…”

MRI for detection of anomalous pulmonary venous drainage in patients with sinus venosus atrial septal defects

“…In older individuals and in those with restricted acoustic windows TTE confronts difficulties in identifying the presence of APVDs. According to a study of Kronzon et al [23] TTE didn't identify an APVD in any of the patients with SVD. In our study TTE delineated an APVD only in 1 out of 9 SVD patients, who proved to suffer from APVD intraoperatively.…”