Real-time D transesophageal echocardiography for the assessment of secundum atrial septal defects in children Three dimensional transesophageal echocardiography for assessment of atrial septa! defects

Aim: The need for more than one cross-section in the imaging of the atrial septum with two-dimensional (2D) echocardiography creates a limitation in determining the morphology of atrial septal defects (ASD) and negatively affects the success of the percutaneous closure procedure. In this study, measurements of ASDs and surrounding rims obtained by 3D transesophageal echocardiography (TEE) were compared with 2D TEE and angiographic balloon sizing measurements. Material and Methods: The study included 24 pediatric patients with the diagnosis of ASD who were scheduled for transcatheter defect closure. All patients underwent catheter-angiography following a detailed 2D TEE examination. Results: The data of 17 patients with optimal 3D TEE images were analyzed offline in the Q-lab. The diameter of the defects and surrounding rims, which were measured with two- and three-dimensional TEE were similar (p> 0.05). There was a strong correlation between the two measurement techniques in terms of defect diameter (r = 0.896, p <0.001). While the diameter of the defect measured by the sizing balloon was greater than that measured by 2D TEE, it was similar to that measured by 3D TEE (p <0.001, p = 0.14, respectively). There was also a strong correlation between the defect diameter measured by 3D TEE and balloon sizing diameter (r = 0.844. p <0.001). Discussion: The "en face" visualization of the atrial septum with 3D TEE provides adequate identification of the defect morphology and adjacent structures. Furthermore, reliable determination of the defect size by 3D imaging may lead to appropriate device selection without the requirement for invasive measurement techniques such as balloon sizing.