Three-dimensional echocardiography in children with atrial septal defect

The selection of patients for transcatheter or surgical closure of a secundum atrial septal defect requires accurate information regarding the anatomy of the defect such as its maximal diameter and the amount of circumferential tissue rim. Two-dimensional echocardiography is wanting as a means to define selection criteria for atrial septal defect closure. Since the defect is visualised from multiple orthogonal planes, maximal atrial septal defect diameter is widely under-estimated. The transcatheter approach measures the stretched diameter, but cannot be applied alone for patient selection since it does not provide information on the tissue rim. Three-dimensional echocardiography allows unique en face views of the atrial septum. Previous studies have shown the ability of 3-dimensional echocardiography to depict information regarding the shape, the maximal diameter and the rims surrounding the defect. Transthoracic 3-dimensional echocardiography is accurate to measure atrial septal defect maximal diameter and rims surrounding the defect. Such a non-invasive method could be applied to children selection for atrial septal defect closure. The transcatheter balloon method provides additional information such as the resistance of the septum. Device sizing and placement should take into account both 3-dimensional echocardiography and transcatheter findings.