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.

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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