Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1983 Apr;49(4):350–358. doi: 10.1136/hrt.49.4.350

Detection of ostium secundum atrial septal defects by transoesophageal cross-sectional echocardiography.

P Hanrath, M Schlüter, B A Langenstein, J Polster, S Engel, P Kremer, H J Krebber
PMCID: PMC481312  PMID: 6830669

Abstract

Transoesophageal cross-sectional echocardiography has special advantages when investigating the interatrial septum which is imaged perpendicularly without echo dropouts from an oesophageal transducer position. The technique was successfully used in 19 out of 20 patients (95%) with an ostium secundum atrial septal defect and in 30 control subjects. In all of the latter the interatrial septum was visualised as a continuous echo structure separating the atria, whereas a distinct discontinuity representing the septal defect was apparent in all patients with atrial septal defect. Echocardiographic measurement of the defect size correlated well with surgical findings in 11 patients who underwent open heart surgery in the course of this study. In a comparative transthoracic examination, adequate recordings were obtained in 18 of the 20 patients and in 26 of the 30 control subjects. Direct subcostal visualisation of the defect was reliable in 10 of 18 patients. Peripheral venous contrast studies were also performed with the transoesophageal as well as the transthoracic technique. Echo contrast remained confined to the right heart in the control subjects. Left sided contrast appearance diagnostic of an interatrial communication was shown in the patients using the transoesophageal technique (100% sensitivity), with an additional right atrial negative contrast apparent in seven patients. The transthoracic approach, on the other hand, showed left sided echo contrast in 14 of 18 patients and an additional negative contrast effect in two of the 14. It is concluded that transoesophageal is superior to transthoracic cross-sectional echocardiography as a highly sensitive method for the detection and evaluation of ostium secundum atrial septal defects.

Full text

PDF
350

Images in this article

Selected References

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

  1. Bierman F. Z., Williams R. G. Subxiphoid two-dimensional imaging of the interatrial septum in infants and neonates with congenital heart disease. Circulation. 1979 Jul;60(1):80–90. doi: 10.1161/01.cir.60.1.80. [DOI] [PubMed] [Google Scholar]
  2. Bourdillon P. D., Foale R. A., Rickards A. F. Identification of atrial septal defects by cross-sectional contrast echocardiography. Br Heart J. 1980 Oct;44(4):401–405. doi: 10.1136/hrt.44.4.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dillon J. C., Weyman A. E., Feigenbaum H., Eggleton R. C., Johnston K. Cross-sectional echocardiographic examination of the interatrial septum. Circulation. 1977 Jan;55(1):115–120. doi: 10.1161/01.cir.55.1.115. [DOI] [PubMed] [Google Scholar]
  4. Fraker T. D., Jr, Harris P. J., Behar V. S., Kisslo J. A. Detection and exclusion of interatrial shunts by two-dimensional echocardiography and peripheral venous injection. Circulation. 1979 Feb;59(2):379–384. doi: 10.1161/01.cir.59.2.379. [DOI] [PubMed] [Google Scholar]
  5. Hisanaga K., Hisanaga A., Hibi N., Nishimura K., Kambe T. High speed rotating scanner for transesophageal cross-sectional echocardiography. Am J Cardiol. 1980 Nov;46(5):837–842. doi: 10.1016/0002-9149(80)90437-3. [DOI] [PubMed] [Google Scholar]
  6. Karnegis J. N., Heinz J. The risk of diagnostic cardiovascular catheterization. Am Heart J. 1979 Mar;97(3):291–297. doi: 10.1016/0002-8703(79)90427-7. [DOI] [PubMed] [Google Scholar]
  7. Kronik G., Mösslacher H. Positive contrast echocardiography in patients with patent foramen ovale and normal right heart hemodynamics. Am J Cardiol. 1982 May;49(7):1806–1809. doi: 10.1016/0002-9149(82)90263-6. [DOI] [PubMed] [Google Scholar]
  8. Kronik G., Mösslacher H., Schmoliner R., Hutterer B. Kontrastechokardiographie bei Patienten mit kleinen interatrialen Kurzschlussverbindungen (offenes Foramen ovale). Wien Klin Wochenschr. 1980 Apr 11;92(8):290–293. [PubMed] [Google Scholar]
  9. Kronik G., Slany J., Moesslacher H. Contrast M-mode echocardiography in diagnosis of atrial septal defect in acyanotic patients. Circulation. 1979 Feb;59(2):372–378. doi: 10.1161/01.cir.59.2.372. [DOI] [PubMed] [Google Scholar]
  10. Lange L. W., Sahn D. J., Allen H. D., Goldberg S. J. Subxiphoid cross-sectional echocardiography in infants and children with congenital heart disease. Circulation. 1979 Mar;59(3):513–524. doi: 10.1161/01.cir.59.3.513. [DOI] [PubMed] [Google Scholar]
  11. Lieppe W., Scallion R., Behar V. S., Kisslo J. A. Two-dimensional echocardiographic findings in atrial septal defect. Circulation. 1977 Sep;56(3):447–456. doi: 10.1161/01.cir.56.3.447. [DOI] [PubMed] [Google Scholar]
  12. Mandelstam P., Sugawa C., Silvis S. E., Nebel O. T., Rogers B. H. Complications associated with esophagogastroduodenoscopy and with esophageal dilation. Gastrointest Endosc. 1976 Aug;23(1):16–19. doi: 10.1016/s0016-5107(76)73568-5. [DOI] [PubMed] [Google Scholar]
  13. Schapira J. N., Martin R. P., Fowles R. E., Popp R. L. Single and two dimensional echocardiographic features of the interatrial septum in normal subjects and patients with an atrial septal defect. Am J Cardiol. 1979 Apr;43(4):816–819. doi: 10.1016/0002-9149(79)90083-3. [DOI] [PubMed] [Google Scholar]
  14. Schlüter M., Langenstein B. A., Polster J., Kremer P., Souquet J., Engel S., Hanrath P. Transoesophageal cross-sectional echocardiography with a phased array transducer system. Technique and initial clinical results. Br Heart J. 1982 Jul;48(1):67–72. doi: 10.1136/hrt.48.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Serruys P. W., van den Brand M., Hugenholtz P. G., Roelandt J. Intracardiac right-to-left shunts demonstrated by two-dimensional echocardiography after peripheral vein injection. Br Heart J. 1979 Oct;42(4):429–437. doi: 10.1136/hrt.42.4.429. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Seward J. B., Tajik A. J., Hagler D. J., Ritter D. G. Peripheral venous contrast echocardiography. Am J Cardiol. 1977 Feb;39(2):202–212. doi: 10.1016/s0002-9149(77)80192-6. [DOI] [PubMed] [Google Scholar]
  17. Seward J. B., Tajik A. J., Spangler J. G., Ritter D. G. Echocardiographic contrast studies: initial experience. Mayo Clin Proc. 1975 Apr;50(4):163–192. [PubMed] [Google Scholar]
  18. Silverman N. H., Schiller N. B. Apex echocardiography. A two-dimensional technique for evaluating congenital heart disease. Circulation. 1978 Mar;57(3):503–511. doi: 10.1161/01.cir.57.3.503. [DOI] [PubMed] [Google Scholar]
  19. Tajik A. J., Seward J. B., Hagler D. J., Mair D. D., Lie J. T. Two-dimensional real-time ultrasonic imaging of the heart and great vessels. Technique, image orientation, structure identification, and validation. Mayo Clin Proc. 1978 May;53(5):271–303. [PubMed] [Google Scholar]
  20. Tei C., Tanaka H., Kashima T., Yoshimura H., Minagoe S., Kanehisa T. Real-time cross-sectional echocardiographic evaluation of the interatrial septum by right atrium-interatrial septum-left atrium direction of ultrasound beam. Circulation. 1979 Sep;60(3):539–546. doi: 10.1161/01.cir.60.3.539. [DOI] [PubMed] [Google Scholar]
  21. Valdes-Cruz L. M., Pieroni D. R., Roland J. M., Varghese P. J. Echocardiographic detection of intracardiac right-to-left shunts following peripheral vein injections. Circulation. 1976 Oct;54(4):558–562. doi: 10.1161/01.cir.54.4.558. [DOI] [PubMed] [Google Scholar]
  22. Weyman A. E., Wann L. S., Caldwell R. L., Hurwitz R. A., Dillon J. C., Feigenbaum H. Negative contrast echocardiography: a new method for detecting left-to-right shunts. Circulation. 1979 Mar;59(3):498–505. doi: 10.1161/01.cir.59.3.498. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES