Evaluation of Atrial and Ventricular Septal Defects with Real-Time Three-Dimensional Echocardiography: Current Status and Literature Review

Three-Dimensional Echocardiographic En Face Views of Ventricular Septal Defects: Feasibility, Accuracy, Imaging Protocols and Reference Image Collection

BACKGROUND

Ventricular septal defect (VSD) is the most common congenital cardiac anomaly. Accurate assessment is critical for planning treatment. Recent advances in three-dimensional (3D) echocardiography have improved image quality and ease of use.

METHODS

The feasibility and accuracy of three specific 3D echocardiographic protocols to demonstrate en face views of VSDs were analyzed in a retrospective review of 100 consecutive patients. Sixty-four patients underwent transthoracic echocardiography and 36 transesophageal echocardiography. Types of VSDs included 34 muscular, 32 perimembranous, 18 malaligned, 11 inlet, four outlet, and one acquired. Ages ranged from 1 day to 77 years, and body weights from 3 to 92 kg. Three-dimensional echocardiographic full-volume mode with standard XYZ and adjustable plane cropping, 3D full-volume mode with iCrop, and narrow-sector live 3D protocols were compared for feasibility and accuracy to obtain a diagnostic-quality en face view of a VSD.

RESULTS

The success rate for obtaining a high-quality en face image for the three protocols was 100% for full-volume mode with iCrop, 97% for full-volume standard mode, and 94% for narrow-sector live 3D mode. The ability of both full-volume mode with iCrop and full-volume standard mode to demonstrate a VSD was slightly better than that of narrow-sector live 3D mode (P < .001 for both vs narrow-sector live 3D mode). In all patients, the type, size, and location of the VSD were demonstrated accurately by two or more of the protocols.

CONCLUSIONS

Three-dimensional echocardiography of VSDs is feasible and accurate in most patients using defined protocols. The protocols are described and illustrated in detail, and a reference 3D image collection is presented.

Three-dimensional transesophageal echocardiography of atrial septal defect device closure

Most secundum atrial septal defects (ASD) are amenable to device closure. Three- dimensional transesophageal echocardiography (3DTEE) can be used to obtain an en face view of the ASD and important surrounding structures which provides for analysis of the type, size, shape, orientation, number and position of orifices, ASD rims and important surrounding structures in a single live 3D echo view. Also, 3DTEE is ideal for monitoring the position and configuration of devices and delivery hardware using live real -time imaging techniques. In this chapter we will describe and illustrate the methods to obtain and optimize 3DTEE en face views of the ASD during device closure using 3D zoom, live 3D and 3D full volume plus iCrop modalities. The respective 3D TEE modalities, imaging protocols, advantages and limitations will be discussed. Because it is useful, accurate and fairly simple to use, we have adopted 3D TEE for routine clinical use during ASD device closure.