Anaesthesia

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Browsing Anaesthesia by Author "Ankur Joshi"

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    Intraoperative assessment of atrial septal defect morphology using 3d transesophageal echocardiography vs 2d transesophageal echocardiography
    (SCTIMST, 2019-12) Ankur Joshi
    Advances in perioperative care for children with congenital heart diseases (CHD) over the past few decades have resulted in an increasing number of these children reaching adulthood. Also the present day advanced and non invasive imaging techniques have started diagnosing CHDs in adults, who were earlier missed. Although surgical cure is the goal – a true universal cure, without any residua, is uncommon on a population wide cover. Exceptions however include closure of Atrial Septal Defects (ASD) and non pulmonary hypertensive Patent Ductus Arteriosus (PDA). Atrial Septal Defects are one of the most common congenital defects encountered in adult population, accounting for 30-40% of the total intracardiac shunts in adults. (1, 2) They account for 6-10% of the congenital heart effects (CHD), with an incidence of 1in 1500 live births. (3) The patent foramen ovale though, is more common and is present in 20-25% of adults. (4) Accurate preoperative determination of an atrial septal defect location and size is important, not only for a successful transcatheter closure but also to ascertain the feasibility and choice between a device closure and open repair of the ASD. A successful transcatheter closure of the defect requires reliable preoperative imaging of the location and size of the defects as well as the information on the relationship of the rim length to the neighboring cardiac structures. (5, 6)Intraoperative assessment of atrial septal defect morphology using3D transoesophageal echocardiography vs2D transoesophageal echocardiography Page 4 Although 2D Transesophageal echocardiography (2D-TEE) has been widely used for the preoperative assessment of ASD, it does not always provide reliable information on the maximal defect size and the minimal rim length due to imaging of the defect in a single cross section at a time. (7, 8) 3D echocardiography provides an enface view of the ASD and the relationship with adjacent structures, thus eliminating some of the drawbacks of 2D imaging. (9,10) Earlier 3D studies have also described the dynamic nature of the ASD size during the phases of the cardiac cycle. (11,12) We hypothesized that 3D-TEE is more accurate in evaluating the location, size and the Atrial septal margins of a secundum ASD compared to 2D-TEE, when correlated on the operation theatre (OT) table with measurements performed by the surgeon.