A new anatomical approach for congenital valvular disease by three-dimensional echocardiography.

Congenital valvular heart disease in childhood is often complex. Convention al echocardiography provides two-dimensional views which require mental rec onstruction for three-dimensional assessment. This problem may be solved by the use of three-dimensional (3D) echocardiography which obtains images of valves comparable to those seen at surgery. This was confirmed by 4 cases of congenital valvular heart disease studied by 3D echocardiography : stenotic bicuspid aortic valve disease, parachute mitral valve and two cases of mitral regurgitation in patients with atriove ntricular canal. The 3D views of the aortic valve showed the commissural op ening after percutaneous balloon valvuloplasty of the bicuspid valve. The s urface of the aortic orifice and the surface of the two mitral leaflets wer e measured from 3D reconstructions. The longitudinal 3D view analysed the e xtension of the single obstructive mitral papillary muscle of the parachute malformation. The 3D ventricular views allowed assessment of the extension of the cleft and the surface of the three mitral leaflets of the 2 cases o f atrioventricular canal. In one of these cases, the results of surgical va lvuloplasty were evaluated after 3D reconstruction of the valve. 3D echocardiography is not only a diagnostic tool for congenital heart dise ase but also a very useful complementary investigation for accurate evaluat ion of congenital valvular lesions to optimise possible valve repair.