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. 1997 Oct;78(4):382–389. doi: 10.1136/hrt.78.4.382

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

A Lange 1, M Walayat 1, C Turnbull 1, P Palka 1, P Mankad 1, G Sutherland 1, M Godman 1
PMCID: PMC1892258  PMID: 9404256

Abstract

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.

 Keywords: atrial septal defect;  morphology;  three dimensional echocardiography;  magnetic resonance imaging

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Figure 1  .

Figure 1  

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Steps taken to acquire three dimensional dataset. Diagram shows an ECG and respiration gated acquisition of two dimensional cross sections obtained from the apical window by rotating the transducer by the mechanical device at 2° steps over 180°. Once the acquisition was completed, off-line processing based on the interpolation of the missing information between the acquired two dimensional images at 2° steps and conversion of the images from polar to Cartesian coordinates was carried out.

Figure 2  .

Figure 2  

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The schematic presentation of the atrial septal defect (ASD) as seen by the surgeon. CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; RA, right atrium; SVC, superior vena cava; TV, tricuspid valve.

Figure 3  .

Figure 3  

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Maximum orifice of an atrial septal defect (ASD) as defined by three dimensional echocardiography (A), phase contrast cine magnetic resonance imaging (B), and surgery (C). CS, coronary sinus; DMI, Doppler myocardial imaging; GSI, grey scale imaging; IVC, inferior vena cava; SVC, superior vena cava; TV, tricuspid valve.

Figure 4  .

Figure 4  

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Changes in atrial septal defect (ASD) dimension during a cardiac cycle as seen by three dimensional Doppler myocardial imaging echocardiography.

Figure 5  .

Figure 5  

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Linear regression analysis of the correlation between the patient's age and the dynamic changes in atrial septal defect (ASD) dimension during the cardiac cycle. The differences in ASD dimension changes were calculated as follows: [(HED - HES) + (VED - VES) / (HED + VED)] × 100%, where HED = horizontal end diastolic dimension, HES = horizontal end systolic dimension, VED = vertical end diastolic dimension, and VES = vertical end systolic dimension. Circles, Doppler myocardial imaging; squares, grey scale imaging. The dotted lines indicate the 95% predictive interval.

Figure 6  .

Figure 6  

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Bland and Altman analysis of the accuracy of atrial septal defect (ASD) dimension measurements by three dimensional echocardiography using both grey scale images and the Doppler myocardial imaging technique against phase contrast cine magnetic resonance imaging (A, B) or surgery (C, D). Empty squares, horizontal dimensions of ASDs by grey scale images; filled squares, vertical dimensions of ASDs by Doppler myocardial imaging; empty circles, horizontal dimensions of ASDs; filled circles, vertical dimensions of ASDs. The solid line shows the mean difference between the techniques used; the dotted lines show the 95% limit of agreement.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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