Transthoracic three-dimensional echocardiography in the preoperative assessment of atrioventricular septal defect morphology

A prospective study of 3-dimensional (3-D) transthoracic echocardiographic definition of atrioventricular septal defect (AVSD) morphology and ifs dyna mic changes during the cardiac cycle was performed. The information obtaine d from 2-D and 3-D transthoracic echocardiography Fl was compared with intr aoperative findings in an unselected group of 15 patients with AVSD (median age 22 months). in all study patients, 3-D reconstructions provided anatom ic views of the atrioventricular valve(s) en face from either atrial or ven tricular perspectives that allowed comprehensive assessment of dynamic valv e morphology and the mechanism of valve reflux. Left-sided valve function w as correctly assessed by 2-D TTE in 11 of 15 patients (73%) and in 14 of 15 (93%) by 3-D TTE. In 6 of 15 patients (40%), the severity of right-sided v alve reflux was described precisely by 2-D TTE and in 12 of 15 patients (80 %) by 3-D TTE. Additionally, 3-D TCE supplemented the diagnostic informatio n to that available from 2-D TTE on atrial and ventricular septal defects. Although primum atrial septal defects were depicted by 2-D and 3-D TTE in a ll 15 patients, the description of defect size was more precise by the 3-D TTE (80% vs 100%, respectively). The presence of secundum atrial septal def ect was correctly diagnosed by both TTE techniques in 10 of 15 patients. Di sagreement regarding the size of the defect was present only in 2 of 10 pat ients by 2-D TTE. in another 2 patients, 3-D TTE described multiple defect fenestrations that were missed by 2-D TTE, Thus, the agreement score was 73 % for 2-D and 100% for 3-D echo. The agreement for the presence and siting of ventricular septal defects was 67% for 2-D and 93% for 3-D echo. We conc lude that 3-D TTE provided accurate anatomic reconstructions of the common atrioventricular junction and that the use of dynamic 3-D TTE enhanced the anatomic diagnostic capability of standard 2-D TTE. (C)2000 by Excerpta Med ica, Inc.