Real-time transthoracic three-dimensional echocardiography versus two-dimensional transthoracic echocardiography in the assessment of secondum type atrial septal defect in pediatrics
Keywords:
Atrial Septal Defect, Two-Dimensional Transthoracic Echocardiography, Three-Dimensional Transthoracic EchocardiographyAbstract
Background: Atrial septal defect (ASD) is among the most frequently encountered congenital heart anomalies, with the secundum type being the most prevalent. This defect results in abnormal blood flow between the pulmonary and systemic circulations. The purpose of this study was to assess secundum ASD using transthoracic three-dimensional echocardiography (3D TTE) and compare its findings with those obtained from traditional two-dimensional transthoracic echocardiography (2D TTE).
Research design and Methods: This prospective cohort study included 38 children with secondum ASD amenable to transcatheter closure aged 2 to 18 years who presented to catheterization labs.
Results: The maximal size of the ASD was more accurately assessed with 3D TTE and was positively correlated with device size.
Conclusions: Three-dimensional echocardiography is a valuable modality for evaluating ASDs, particularly for assessing suitability for device closure and determining orientation. It also provides precise measurements of defect diameter, aiding in selecting an appropriately sized device and potentially eliminating the need for balloon sizing.
References
1. Abohamar MD, Ashmawy MM, Kasem HK, Hamdy EA, El Sheikh RG. Original article--predictors of persistent functional tricuspid regurgitation after transcatheter closure of atrial septal defect and its relationship to tricuspid valve remodeling. J Saudi Heart Assoc. 2021;33(1):53-60. doi:10.37616/2212-5043.1241
2. Brida M, Chessa M, Celermajer D, et al. Atrial septal defect in adulthood: a new paradigm for congenital heart disease. Eur Heart J. 2022;88(28):2660-71. doi:10.1093/eurheartj/ehab646
3. SM M, P Nakhostin D, MY Aarabi M, A Shah M. Assessment of the results of secundum atrial septal defect closure by two surgery [right thoracotomy] and intervention [transcatheter amplatzer septal occluder]. Eur Heart J Cardiovasc Imaging. 2010;178(5):27-55.
4. Cao C, Li R, Huang J, et al. Feasibility of transcatheter closure of secundum atrial septal defect in low weight infants under 2-year-old from a 3-year retrospective cohort study. Am J Cardiol. 2020;132(55):133-9. doi:0.1016/j.amjcard.2020.06.011
5. Awad SM, Cao QL, Hijazi ZM. Intracardiac echocardiography for the guidance of percutaneous procedures. Curr Cardiol Rep. 2009;11(3):210-5. doi:10.1007/s11886-009-0030-z
6. Chessa M, Carminati M, Butera G, et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol. 2002;39(6):1061-5. doi:10.1016/s0735-1097(02)01711-4
7. Jang JY, Heo R, Cho MS, et al. Efficacy of 3D transoesophageal echocardiography for transcatheter device closure of atrial septal defect without balloon sizing. Eur Heart J Cardiovasc Imaging. 2018;19(6):684-9. doi:10.1093/ehjci/jex153
8. Simpson J, Lopez L, Acar P, et al. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30(1):1-27. doi:10.1016/j.echo.2016.08.022
9. Roushdy A, El Sayegh A, Ali YA, et al. A novel three-dimensional echocardiographic method for device size selection in patients undergoing ASD trans-catheter closure. Egypt Heart J. 2019;72(1):1-28. doi:10.1186/s43044-019-0038-7
10. Johri AM, Witzke C, Solis J, et al. Real-time three-dimensional transesophageal echocardiography in patients with secundum atrial septal defects: outcomes following transcatheter closure. J Am Soc Echocardiogr. 2011;24(4):431-7. doi:10.1016/j.echo.2010.12.011
11. Lodato JA, Cao QL, Weinert L, et al. Feasibility of real-time three-dimensional transoesophageal echocardiography for guidance of percutaneous atrial septal defect closure. Eur J Echocardiogr. 2009;10(4):543-8. doi:10.1093/ejechocard/jen337
12. Acar P, Saliba Z, Bonhoeffer P, et al. Influence of atrial septal defect anatomy in patient selection and assessment of closure with the Cardioseal device; a three-dimensional transoesophageal echocardiographic reconstruction. Eur Heart J. 2000;21(7):573-81. doi:10.1053/euhj.1999.1855
13. Tamborini G, Pepi M, Susini F, et al. Comparison of two- and three-dimensional transesophageal echocardiography in patients undergoing atrial septal closure with the amplatzer septal occluder. Am J Cardiol. 2002;90(9):1025-8. doi:10.1016/s0002-9149(02)02695-4
14. Taniguchi M, Akagi T, Watanabe N, et al. Application of real-time three-dimensional transesophageal echocardiography using a matrix array probe for transcatheter closure of atrial septal defect. J Am Soc Echocardiogr. 2009;22(10):1114-20. doi:10.1016/j.echo.2009.06.008
15. Simpson JM, Miller O. Three-dimensional echocardiography in congenital heart disease. Arch Cardiovasc Dis. 2011;104(1):45-56. doi:10.1016/j.acvd.2010.11.004
16. Saha SK, Ahmed CM, Haque T, Al Mamun MA, Hussain MZ. Assessment of atrial septal defects using 3-dimensional transthoracic echocardiography prior to percutaneous device closure: first report from Bangladesh. Ther Adv Cardiovasc Dis. 2023;17(5):55-66. doi:10.1177/17539447231193290
17. Anwar AM, Nosir YF, Zainal-Abidin SK, Ajam A, Chamsi-Pasha H. Real-time three-dimensional transthoracic echocardiography in daily practice: initial experience. Cardiovasc Ultrasound. 2012;10(5):14-25. doi:10.1186/1476-7120-10-14
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Copyright (c) 2026 Rawan Eldeeb, Osama Toulba , Raghda El Sheikh , Walid Elshehaby , Hani Adel

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