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Updated: Oct 10, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Transthoracic three-dimensional echocardiography in the preoperative assessment of atrioventricular septal defect
1Department of Cardiology, Royal Hospital for Sick Children, Edinburgh, Scotland. AlekLange@hotmail.com
Insights
Three-dimensional (3-D) transthoracic echocardiography (TTE) offers superior visualization of atrioventricular septal defects (AVSD) compared to 2-D TTE. Dynamic 3-D TTE enhances diagnostic accuracy for valve function and septal defects in AVSD patients.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Cardiology
Background:
- Atrioventricular septal defects (AVSD) are complex congenital heart conditions requiring precise diagnosis.
- Standard 2-dimensional transthoracic echocardiography (2-D TTE) has limitations in fully characterizing AVSD morphology and valve dynamics.
- Advanced imaging techniques are crucial for improving diagnostic accuracy in pediatric congenital heart disease.
Purpose of the Study:
- To evaluate the diagnostic accuracy of 3-dimensional transthoracic echocardiography (3-D TTE) in defining AVSD morphology and dynamic changes.
- To compare the effectiveness of 3-D TTE with conventional 2-D TTE in assessing valve function and septal defects in AVSD patients.
- To determine if 3-D TTE enhances the diagnostic capabilities beyond standard 2-D TTE.
Main Methods:
- A prospective study involving 15 pediatric patients with AVSD (median age 22 months).
- Comparison of intraoperative findings with information obtained from both 2-D TTE and 3-D TTE.
- Detailed analysis of 3-D reconstructions for atrioventricular valve morphology, valve reflux, and atrial and ventricular septal defects.
Main Results:
- 3-D TTE provided comprehensive en face views of atrioventricular valves, enabling detailed assessment of dynamic morphology and reflux mechanisms.
- Left-sided valve function assessment accuracy: 73% for 2-D TTE vs. 93% for 3-D TTE.
- Right-sided valve reflux assessment accuracy: 40% for 2-D TTE vs. 80% for 3-D TTE.
- 3-D TTE demonstrated superior precision in sizing primum atrial septal defects (100% vs. 80%) and identified multiple fenestrations missed by 2-D TTE.
- Agreement scores for ventricular septal defects: 67% for 2-D TTE vs. 93% for 3-D TTE.
Conclusions:
- 3-D TTE provides accurate anatomic reconstructions of the common atrioventricular junction in AVSD.
- Dynamic 3-D TTE significantly enhances the diagnostic capability compared to standard 2-D TTE.
- 3-D TTE improves the assessment of valve function and septal defects in patients with AVSD.
Abstract:
A prospective study of 3-dimensional (3-D) transthoracic echocardiographic definition of atrioventricular septal defect (AVSD) morphology and its dynamic changes during the cardiac cycle was performed. The information obtained from 2-D and 3-D transthoracic echocardiography (TTE) was compared with intraoperative findings in an unselected group of 15 patients with AVSD (median age 22 months). In all study patients, 3-D reconstructions provided anatomic views of the atrioventricular valve(s) en face from either atrial or ventricular perspectives that allowed comprehensive assessment of dynamic valve morphology and the mechanism of valve reflux. Left-sided valve function was 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 valve reflux was described precisely by 2-D TTE and in 12 of 15 patients (80%) by 3-D TTE. Additionally, 3-D TTE supplemented the diagnostic information 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 all 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 defect was correctly diagnosed by both TTE techniques in 10 of 15 patients. Disagreement regarding the size of the defect was present only in 2 of 10 patients 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 sizing of ventricular septal defects was 67% for 2-D and 93% for 3-D echo. We conclude 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. Medica, Inc.
