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Assessment of atrial septal defect morphology by transthoracic three dimensional echocardiography using standard grey scale and Doppler myocardial imaging techniques: comparison with magnetic resonance imaging and intraoperative findings
  1. Aleksandra Langea,
  2. Mohammed Walayatb,
  3. Colin M Turnbullc,
  4. Przemyslaw Palkaa,
  5. Pankaj Mankadb,
  6. George R Sutherlanda,
  7. Michael J Godmanb
  1. aDepartment of Cardiology, Western General Hospital, Edinburgh, UK, bDepartment of Cardiology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, UK, cDepartment of Radiology, Western General Hospital, Edinburgh, UK
  1. Dr Lange, Department of Cardiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.


Objective To determine whether transthoracic three dimensional echocardiography is an accurate non-invasive technique for defining the morphology of atrial septal defects (ASD).

Methods In 34 patients with secundum ASD, mean (SD) age 20 (17) years (14 male, 20 female), the measurements obtained from three dimensional echocardiography were compared to those obtained from magnetic resonance imaging (MRI) or surgery. Three dimensional images were constructed to simulate the ASD view as seen by a surgeon. Measured variables were: maximum and minimum vertical and horizontal ASD dimension, and distances to inferior and superior vena cava, coronary sinus, and tricuspid valve. In each patient two ultrasound techniques were used to acquire three dimensional data: standard grey scale imaging (GSI) and Doppler myocardial imaging (DMI).

Results Good correlation was found in maximum ASD dimension (both horizontal and vertical) between three dimensional echocardiography and both MRI (GSI r = 0.96, SEE = 0.05 cm; DMI r = 0.97, SEE = 0.04 cm) and surgery (GSI r= 0.92, SEE = 0.06 cm; DMI r = 0.95, SEE = 0.06 cm). The systematic error was similar for both three dimensional techniques when compared to both MRI (GSI = 0.40 cm (27%); DMI = 0.38 cm (25%)) and surgery (GSI = 0.50 cm (29%); DMI = 0.37 cm (22%)). A significant difference was found in both horizontal and vertical ASD dimension changes during the cardiac cycle. This change was inversely correlated with age. These findings were consistent for both DMI and GSI technique. In children (age ⩽ 17 years), the feasibility of detecting structures and undertaking measurements was similar for both echo techniques. However, in adult ASD patients (age ⩾ 18 years) this feasibility was higher for DMI than for GSI.

Conclusions Transthoracic three dimensional imaging using both GSI and DMI accurately displayed the varying morphology, dimensions, and spatial relations of ASD. However, DMI was a more effective technique than GSI in describing ASD morphology in adults.

  • atrial septal defect
  • morphology
  • three dimensional echocardiography
  • magnetic resonance imaging

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