Three-dimensional transesophageal echocardiography of the atrial septal defects

Login or register to view PDF.


It has been demonstrated that 3D-TEE is an useful non-invasive tool for evaluating defects of atrial tabication and other anatomical details 11, and it has a better anatomic correlation with matched anatomic specimens than with the corresponding 2D images alone 10. With 3D images there was a better spatial appreciation of the surrounding structures providing a more “realistic” conceptualization of the cardiac anatomy, particularly with structures located at different tomographic planes 6,12, and it`s dynamic changes during the cardiac cycle 13. Irregularities in shape of the ASDs can lead to residual shunting that, as in the case of Figure 1, may require overlapping septal occlusion devices to treat it 14.

It is important to highlight some pitfalls at the time of the 3D interpretation. One must carefully observe for any mismatch among consecutive slices caused by rotation of the probe, which may lead to anatomy distortion. In addition, because the threshold between the solid and liquid interfaces is manually done, inappropriate adjustment may be an operator-dependent pitfall. This may result in either creation of an artifact or deletion of real anatomic segments. At the time of reconstruction radial artifacts can appear. This kind of problem is typical of the technique and it may be appreciated over the endocardial atrial surface in Figure 4.

Considering the wide spectrum of the ASDs and their association with others heart structures it is probable that, in the future, 3D reconstruction of transesophageal images complemented with Doppler analysis will be the technique of choice for studying these patients. Likewise, 3D dynamic echocardiography may represent an excellent method for teaching the pathologic anatomy of diverse complex congenital anomalies, particularly now that patients undergo surgical correction of their malformations at very early ages, limiting the study of anatomic specimens (see additional file).

Dynamic TEE three-dimensional echocardiography enhances the understanding of the anatomy of ASDs and should be an important process in future initiatives for device closures or surgical procedures. Combined with 2D techniques, it is reliable in the preoperative assessment of ASD in adults. This study may be indicated when asymmetrical anatomy is suspected by conventional echocardiography evaluation and may not be necessary if there are unmistakable anatomical information. The question of whether the additional morphologic details obtained by this technique has any significant impact on treatment options of individual patients or not, and the role of novel real time transesophageal transducers, must be investigated."


  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.