Three-dimensional echocardiography can simulate intraoperative visualization of congenitally malformed hearts

Abstract

The new technique of three-dimensional echocardiography can display the studied anatomy in any desired view plane. We sought to establish whether the reconstructions produced could provide views of the heart comparable with those obtained by the surgeon in the operating room. Ninety-four patients, aged 1 day to 19 years (mean, 4.3 years), were examined. The ultrasound probe was placed either on the chest or subcostally and acquired 80 to 100 perpendicular parallel images of the heart with electrocardiographic and respiratory gating. Any plane, in particular oblique planes, within the data set can be analyzed. Whenever possible, the arrangement as seen by the surgeon was photographed, or heart specimens with similar intracardiac lesions were cut to simulate the view of the surgeons, to validate the echo-cardiographic reconstructions. Three-dimensional reconstruction of perimembranous ventricular septal defects, atrial septal defects, or anomalies of the atrioventricular valves could be displayed as viewed through an atriotomy. In similar fashion, reconstructions of muscular or doubly committed ventricular septal defects, along with obstruction of the right ventricular outflow tract, could be prepared as seen through a right ventriculotomy. Obstruction of the left ventricular outflow tract was shown as viewed through an aortotomy. Transthoracic three-dimensional echocardiography provided additional information in the prospective diagnosis of supravalvar mitral membrane, doubly committed subarterial ventricular septal defect, and subaortic stenosis caused by a restrictive ventricular septal defect in double inlet left ventricle. Three-dimensional echocardiography can simulate the display of the heart as seen by the surgeon in the operating room, and therefore can aid in better planning of surgical repair.