Transesophageal echocardiography (TEE) has assumed an important role in atrial septal defects (ASD) study 1, however, when only two-dimensional (2D) images are used for diagnosis, anatomical details can be ignored 2 with significant therapeutic consequences. With the development of fast acquisition for imaging reconstruction, dynamic 3D echocardiography has provided new imaging planes improving the understanding of cardiac anatomy and physiology 3.
Although live/real time three-dimensional (3D) transthoracic and TEE have been recently introduced to the echocardiography armamentarium 4,5, off-line technique allows the use of higher spatial resolution transducers for image acquisition improving anatomical details definition 6. The emergence of new therapeutic options for ASDs demands accurate delineation of their morphology and anatomical relationships 7. The maximal diameter of the defect and the dimensions of the septal rims are essential parameters for the selection of optimal cases for device closure. Our aim was to evaluate if 3D-TEE might help to improve anatomical analysis of ASDs.
In the group of patients with diagnosis of ASD by transthoracic echocardiography (TTE) who underwent clinically indicated TEE, six were prospectively selected to acquire additional planes for 3D reconstruction. The first case had a residual shunt after Ostium Secundum (OS) percutaneous closure. In the second one, TEE was a routine procedure before attempting percutaneous closure of an OS ASD. In the other cases TEE was requested for further information of different types of ASDs detected by transthoracic echocardiography: an Ostium Primun (OP) ASD, a Venous Sinus (VS) type, a Common Atrium (CA) and another more OS ASD with total anomalous pulmonary venous connection to coronary sinus.
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