DIAGNOSIS OF SINUS VENOSUS ATRIAL SEPTAL-DEFECT WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Background Sinus venosus atrial septal defect (SVD) is underdiagnosed with transthoracic echocardiography because of its posterior (far fiel d) location. Transesophageal echocardiography (TEE) should be ideally suited to diagnose SVD, given the proximity of the transducer to the d efect. Methods and Results A retrospective study was undertaken that u sed the medical history, echocardiographic findings, and surgical data of patients identified from computer records as having the diagnosis of SVD during the period in which TEE has been in use (1987 to 1995). Twenty-five patients (14 females and 11 males; median age, 45 years; r ange, 10 to 75 years) with SVD had TEE between 1987 and 1995. Prior tr ansthoracic echocardiography clearly defined the SVD in 3 of these pat ients, and it was suspected in another 11 on the basis of color-flow i maging. Ten patients had unexplained dilatation of the right side of t he heart, which prompted TEE examination. SVD was visualized with TEE in all 25 patients and ranged in size from 1 to 3 cm. Thirty-seven rig ht-sided anomalous pulmonary venous connections were identified in 23 patients. No left-sided anomalous pulmonary venous connections were de tected. Anatomic confirmation was obtained in all 23 surgical patients . No patient required preoperative cardiac catheterization for diagnos is. Conclusions TEE is accurate for the diagnosis of SVD and should be undertaken in any patient with unexplained dilatation of the right si de of the heart. The associated pulmonary venous abnormalities can be identified with TEE. Cardiac catheterization for diagnostic purposes s hould not be required before surgical correction.