Three-dimensional transesophageal echocardiography of the atrial septal defects

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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).

Conclusion
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."

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References
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