[Evaluation of the size of atrial septal defects by subxiphoid approach in two-dimensional echocardiography]

In order to assess whether subxiphoid two-dimensional echography is a reliable method to evaluate the size of atrial septal defects (ASD), we compared echocardiographic and per-operative measurements. We then tried to determine whether the size of the defect correlated with the importance of the shunt at catheterization. The records of 23 patients (16 female, 7 male) operated upon for uncomplicated ASD were selected. Mean age was 23.5 +/- 17.3 years (range: 8 months to 62 years). Two-dimensional echocardiography was performed by the "reversed" subxiphoid route, using two projections: "4-cavity section" and an oblique section, perpendicular to the first one, through the atria and the aortic arch. The greater echographic diameter was compared with the greater diameter measured at surgery. The ASD area, assimilated at echography to a circle, was compared with the per-operative area (elliptic or circular opening depending on whether 1 or 2 dimensions were available). Per-operative diameter and area related to body surface were then correlated with the haemodynamic QP/QS ratio. The location of the ASD proved correct in all cases (ostium secundum 19, sinus venosus 3, inferior vena cava 1). Mean diameters were 22.4 +/- 6.4 mm (range: 12-40 mm) at echocardiography and 23.6 +/- 7 mm (range: 12-45 mm) at surgery. The mean area at echography was slightly superior to that measured per-operatively: 4.3 +/- 2.6 cm2 (1.4-12.5 cm2) versus 3.8 +/- 2.1 cm2 (1.4-8.9 cm2). There was a very good correlation between echographic and per-operative diameters (r = 0.91; p less than 0.001) and areas (r = 0.89; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)