Intraoperative assessment of atrial septal defect morphology using 3d transesophageal echocardiography vs 2d transesophageal echocardiography
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Date
2019-12
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SCTIMST
Abstract
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.