Background The aim of this study was to evaluate the diagnostic relevance o
f 3-dimensional (3D) echocardiography in the assessment of secundum atrial
septum defect (ASD2).
Methods and Results Twenty-three patients (age 2 to 58 years) with an ASD2
were studied by transthoracic (n = 9) or transesophageal (n = 14) echocardi
ography for the acquisition of a 3D data set before undergoing surgical rep
air. Qualitative (location, shape, and structure) and quantitative (largest
and smallest anteroposterior and superoinferior diameters) characteristics
were analyzed and compared with surgical findings. Intraobserver and inter
observer variability were assessed. The gross anatomy of the ASD2, shown by
the 3D images, was confirmed by the surgeon in 21 of 23 patients, but the
presence of membranous or fenestrated remnants of the valvula foramina oval
is in the defect was not optimally visualized in 7 patients. Three-dimensio
nal echocardiography revealed changes in diameter and shape of the ASD2 dur
ing the cardiac cycle. The measured largest and smallest anteroposterior di
ameters and their intraobserver and interobserver agreement were 274 +/- 12
mm, r = 0.95 (P <.001), r = 0.92 (P <.001), and 194 +/- 9 mm, r = 0.96 (P
<.001), r = 0.94 (P <.001), respectively. The measured largest and smallest
superoinferior diameter and their intraobserver and interobserver agreemen
t were 304 +/- 26 mm, r = 0.90 (P <.001), r = 0.97 (P <.001), and 204 +/- 1
0 mm, r = 0.83 (P <.001), r = 0.84 (P <.001), respectively. The correlation
coefficient between 2D and 3D echocardiography for the largest anteroposte
rior and superoinferior diameter was r = 0.69 (P <.001) and r = 0.68 (P =.0
5), respectively. The correlation coefficient between the measurements from
3D reconstructions and direct surgical measurements was r = 0.20 (P = not
significant) and r = 0.57 (P <.05), whereas between 2D and surgery was r =
0.50 (P <.05) and r = 0.26 (P = not significant).
Conclusions ASD2 has a complex morphology. Three-dimensional echocardiograp
hy provides better qualitative and quantitative information on its dynamic
geometry, location, and extension as compared with standard 2D echocardiogr
aphy and might be useful for device selection during catheter-based closure
of ASD2.