Three-dimensional transesophageal echocardiography of the atrial septal defects

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Figure 6: A.- 3D-TEE reconstruction of the interatrial septum as seen from the right side illustrating an OS ASD (1) with a dilated coronary sinus orifice (2) secondary to anomalous pulmonary venous connection. Between both orifices a band corresponding to interatrial septum is observed. B.- An anatomic specimen with the same abnormalities that closely resembles the reconstructed 3D image.


Discussion
Some differences were observed between the 2D and 3D TEE images. In the 2D studies variations in size were visualized depending on the imaging plane. In the 3D studies, accurate spatial anatomy could be corrected by selecting the appropriate cut plain independently of its orientation. Another advantage of the 3D technique was the ability to actually visualize the entire endocardial surface of the defect, rendering a closer anatomic appearance of the heart. The morphologic analysis of all anatomic specimens with a similar degree of septal anomaly correlated well with the echocardiographic findings and the descriptions of defect shape were the same by 2D and 3D studies.

In literature, the real-time 3D TTE has been evaluated for the various features of ASD and the atrial septum. It is non-invasive and has been shown to be a accurate diagnostic method to determine ASD location and size 9, so, why is it necessary to acquire a 3D-TEE?. Off-line 3D TEE has demonstrated its capability to define small and complex cardiac structures7,10. Although sequential acquisition of multiple triggered 2D image planes is time-consuming, it usually allows to obtain higher spatial resolution images in comparison with real time techniques. This aspect can be important for a better definition of atrial septal anatomy and adjacent structures in planning and performing percutaneous device closure of selected cases of ASDs. Maximal diameter of the defect and dimensions of the septal rims are essential parameters for the selection of optimal cases for device closure and in some cases, 3D-TTE may not provide optimal data. Off-line 3D-TEE might help to improve patient selection and assessment of anatomical details.

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References
  1. Graham R, Gelman J: Echocardiographic aspects of percutaneous atrial septal defect closure in adults. Heart Lung Circ. 2001;10:75-8.
  2. Acar P, Saliba Z, Bonhoeffer P, Aggoun Y, Bonnet D, Sidi D, et al. Influence of atrial septal defect anatomy in patient selection and assessment of closure with the Cardioseal device; a threedimensional transoesophageal echocardiographic reconstruction. Eur Heart J 2000;21:573-81.
  3. Roldan FJ, Vargas Barron J. Indications for and information of three-dimensional echocardiography Arch Cardiol Mex 2004;74:S88-92.
  4. Handke M, Heinrichs G, Moser U, Hirt F, Margadant F, Gattiker F, et al. Transesophageal real-time three-dimensional echocardiography methods and initial in vitro and human in vivo studies. J Am Coll Cardiol 2006;48:2070-6.
  5. Pothineni KR, Inamdar V, Miller AP, Nanda NC, Bandarupalli N, Chaurasia P, et al. Initial Experience with Live/Real Time Three-Dimensional TEE. Echocardiography 2007;24:1099-104.
  6. Roldan FJ, Vargas-Barron J, Loredo Mendoza L , Romero-Cárdenas A, Espinola-Zavaleta N, Barragan R, et al. Anatomic correlation of left atrial appendage by three-dimensional echocardiography. J Am Soc Echocardiogr 2001;14:941-44.
  7. Rigatelli G, Braggion G, Cardaioli P, Faggian G. Failed Amplatzer Septal Occluder device implantation due to an embryonic septal remnant. Eur Heart J. 2007;28:309.
  8. Mathewson JW, Bichell D, Rothman A, Ing FF. Absent posteroinferior and anterosuperior atrial septal defect rims: Factors affecting nonsurgical closure of large secundum defects using the Amplatzer occluder.. J Am Soc Echocardiogr 2004;17:62-9.
  9. Acar P, Aggoun Y, Le Bret E, Douste-Blazy MY, Abdel-Massih T, Dulac Y, et al. 3Dtransthoracic echocardiography: a selection method prior to percutaneous closure of atrial septal defects. Arch Mal Coeur Vaiss 2002;95:405-10.
  10. Roldan FJ, Vargas-Barron J, Espinola-Zavaleta N, Romero-Cardenas A, Vazquez-Antona C, Burgueño GY, et al. Three-dimensional echocardiography of the right atrial embryonic remnants. Am J Cardiol 2002;89:99-101.
  11. Roldan FJ, Vargas-Barron J, Espinola-Zavaleta N, Romero-Cardenas A, Keirns C, Vazquez- Antona C, et al. Cor triatriatum dexter: Transesophageal echocardiographic diagnosis and 3- dimensional reconstruction. J Am Soc Echocardiogr 2001;14:634-36.
  12. Maeno YV, Boutin C, Renson LN, Nykanen D, Smallhorn JF. Three-dimensional TEE for secundum atrial septal defects with a large eustachian valve. Circulation. 1999;25;99.
  13. Xie MX, Fang LY, Wang XF, Lu Q, Lu XF, Yang YL, et al. Assessment of atrial septal defect area changes during cardiac cycle by live three-dimensional echocardiography J Cardiol 2006;47:181-187.
  14. Awaida JP, Moreiras JM, Palacios IF. Three overlapping septal occlusion devices to treat residual shunting across an atrial septal defect. Eur Heart J. 2007;28:385.