Assessment Of Ventricular Septal Defects Research Articles

Assessment of ventricular septal defects by real-time three-dimensional echocardiography and comparison with surgical measurements

BackgroundThree-dimensional (3D) echocardiography has facilitated evaluation of a ventricular septal defect (VSD) with its true dimensions and exact localization and improved identification of various anatomical characteristics in different types of VSDs. ObjectivesWe aimed at investigating the feasibility of 3D echocardiography in assessing VSDs in comparison to two-dimensional (2D) echocardiography. MethodsWe employed both 2D and 3D echocardiography for measuring the longest diameter of VSD. The morphology, number, and size of the defect as well as its relation and distance to the tricuspid and aortic valves were analyzed by 3D echocardiography displaying the VSD from the right ventricular aspect. The size was defined in terms of maximum area, long and short axis diameters at end-diastole. The longest diameters of VSDs were compared with 2D and 3D echocardiography data in all patients as well as with the intra-operative findings in 17 patients. ResultsThe mean diameters of end-diastolic VSDs measured by 3D echocardiography from the right ventricular aspect were significantly larger than those obtained by 2D echocardiography (15.6 ± 8.2 vs 10 ± 4.2 mm, P = .02), however, there was a good correlation between them (r = 0.73, P < .001). 3D echocardiography proved to be superior to 2D echocardiography for visualizing the shape of VSD and for measuring tissue rims from the aortic and tricuspid valves. The advantage was prominent in particular for viewing defects hidden by a ventricular septal aneurysm or a tricuspid septal leaflet, which can be erased digitally to reveal the VSD underneath. The dimensions of VSDs obtained by 3D echocardiography (r = 0.85, P < .001) correlated significantly better with actual dimensions revealed during surgery as compared to those obtained by 2D echocardiography (r = 0.53, P = .03). ConclusionsThe study demonstrated that 3D echocardiography provides more reliable information from both qualitative and quantitative aspects regarding the morphology, size, and tissue rims of VSD compared to 2D views.

21 Decision-making using multimodality imaging in complex muscular ventricular septal defects post pulmonary artery banding

Large muscular ventricular septal defects below the moderator band are an interesting entity as these lesions can be surgical challenging. The conventional approach is to do pulmonary artery banding to control heart failure and allow child to grow with view to close later using interventional approach if the lesion remains significant. Hybrid approach with pulmonary artery debanding and per-ventricular VSD closure has been attempted in few centres. Current advances in multimodality imaging helps us to understand the anatomy better and help us to plan the interventional and surgical procedure well. We present 3 cases of muscular ventricular septal defects post pulmonary artery banding. The VSDs in these patients had multiple exits in right ventricle aspect extending above and below the moderator band. Assessment of ventricular septal defect using transthoracic echocardiography, 3D echocardiography, conventional angiogram and CT angiogram added more information. However along with 3D modelling and printing in these selected cases helped to preempt challenges and plan according to avoid complications. We demonstrate the use of multimodality imaging and 3D modelling in these case series.

Feasibility and accuracy of real-time three-dimensional echocardiographic assessment of ventricular septal defects—comparative study with 2D echocardiography and surgical findings

Feasibility and accuracy of real-time three-dimensional echocardiographic assessment of ventricular septal defects—comparative study with 2D echocardiography and surgical findings

Feasibility and Accuracy of Real-time 3-Dimensional Echocardiographic Assessment of Ventricular Septal Defects

The aim of this study was to evaluate feasibility, accuracy, and clinical applicability of real-time (RT) transthoracic 3-dimensional (3D) echocardiography (3DE) in the determination of the position, size, and shape of a ventricular septal defect (VSD). In all, 34 patients (age: 2 months-46 years), who were scheduled for surgical closure of a VSD, were enrolled in the study. VSD localization, shape, and dimensions were assessed and compared with measurements performed by the surgeon. Acquisition of RT-3DE datasets was feasible in 30 of 34 (88%) patients. Duration of 3D data acquisition was 6 +/- 2 minutes. Reconstruction time was 23 +/- 16 minutes. Localization and number of VSD were determined correctly by RT-3DE in all patients. There was a good correlation for VSD measurements between RT-3DE and operation (r = 0.95). RT-3DE allows accurate determination of VSD size, shape, and location. The short acquisition time and acceptable reconstruction time make this technique clinically applicable.

O12-06 Real time three-dimensional echocardiographic images enhance assessment of ventricular septal defect and ventricular septal aneurysm

O12-06 Real time three-dimensional echocardiographic images enhance assessment of ventricular septal defect and ventricular septal aneurysm

Three-dimensional echocardiography enhances the assessment of ventricular septal defect

By 3-dimensional echocardiography, the location, relation to the aortic and tricuspid valve, and the size of the ventricular septal defect was assessed and compared with 2-dimensional echocardiography and intraoperative findings. We concluded that 3-dimensional echocardiography accurately assesses the anatomy of the ventricular septal defect, provides additional information, and can be considered a valuable preoperative diagnostic tool.

Echocardiography and cardiac catheterization in the preoperative assessment of ventricular septal defect in infancy

Background Cardiac catheterization is commonly performed before repair of ventricular septal defect (VSD) in infancy. No study has addressed the accuracy of echocardiography alone in defining all of the important anatomic features in this population. Methods Consecutive infants undergoing VSD repair between 1991 and 1995 (n = 156) were reviewed. The number of additional VSDs and the presence of commonly associated lesions were recorded for each technique and compared with a reference standard consisting of a combination of surgical findings plus postoperative echocardiography and clinical findings. The associated lesions were right ventricular muscle bundles, subaortic ridge, and persistent ductus arteriosus. Results The sensitivity and specificity of echocardiography in the detection of additional VSDs was 60% and 99% compared with 53% and 97% for cardiac catheterization and 73% and 96% for both techniques. These differences were not statistically significant. No differences were seen in the detection of commonly associated lesions. Conclusion Routine preoperative cardiac catheterization for infants with a primary diagnosis of VSD is probably no longer justified. Am Heart J 1998;135:907-13.)

Intraoperative TEE assessment of ventricular septal defect with aortic regurgitation

It is desirable to repair but not replace the aortic valve in patients with ventricular septal defect and acquired aortic regurgitation. Precise definition of the valvar pathology with monitoring of its repair perioperatively would enhance the surgical management of this condition. Fourteen consecutive patients (age, 10.6 +/- 6 years; weight 29.7 +/- 5.7 kg) who underwent repair of ventricular septal defect with aortic regurgitation were studied by intraoperative transesophageal echocardiography. The severity of prolapse of each of the individual aortic cusps and its adjacent sinus was assessed and the valvar regurgitation quantified by Doppler-derived regurgitant indices. The echocardiographic and surgical findings were correlated and the preoperative and postoperative echocardiographic data were compared to assess the effectiveness of operation. Eight subarterial and six perimembranous defects were located accurately and their sizes (11.8 +/- 3.0 mm) correlated well (r = 0.80) with the surgical measurements. Transesophageal echocardiography detected prolapse of the aortic valve and its sinus in all 14 patients. The severity of the prolapse was severe in 10, moderate in 4, and mild in 5 leaflets. One the basis of these findings, together with the Doppler-derived mean regurgitant indices, exploration of the valve and valvuloplasty were executed appropriately in 12 of 14 patients. In all 14 patients, transesophageal echocardiography after bypass revealed no further cuspal prolapse and significant reduction of the mean regurgitant index (0.55 +/- 0.23 to 0.17 +/- 0.15, p < 0.0001). Residual ventricular septal defect was detected in 5 patients and the only patient with significant shunting who required reexploration was identified correctly. Intraoperative transesophageal echocardiography can assess effectively the surgical repair of ventricular septal defect with aortic regurgitation and provide information that directs and alters surgical plans to the benefit of patients.

Assessment of ventricular septal defect with aortic valvar prolapse by means of echocardiography and angiography

SummaryA total of 80 patients, diagnosed by echocardiography as having ventricular septal defect with aortic valvar prolapse, underwent cardiac catheterization and surgery. Echocardiographic and angiographic results were compared with surgical findings. The ventricular septal defects as observed during surgery were found to be doubly committed and subarterial in 49 (61%), muscular outlet in 10 (13%), and perimembranous in 21(26%). The location had been erroneously categorized by echocardiography and angiography in 12 (15%) and in 15 (19%) patients, respectively. Prolapse of the right coronary leaflet of the aortic valve, as documented by echocardiography, was confirmed by angiography in all but two cases. Prolapse of the noncoronary leaflet was detected by both imaging modalities in three patients. Prolapse of the right coronary and noncoronary leaflets was observed at surgery in 49 and three patients, respectively. The mean size of the ventricular septal defect, when measured by echocardiography, was significantly smaller than that found following surgical measurements (3.3±1.3 vs 8.4±3.8 mm, p&lt;0.001). Our study showed that the ventricular septal defect was erroneously classified in the presence of prolapse of the aortic valve in 15% and 19% of our cases by echocardiography and angiography, respectively. The herniated sinus of Valsalva forming the “roof” of the ventricular septal defect probably redirected the jet across the defect to cause the errors in interpretation. Echocardiography, nevertheless, is as reliable as angiography in our hands in the follow-up of patients with ventricular septal defect opening to the outlet of the right ventricle.

Two-Dimensional and Color Doppler Assessment of Ventricular Septal Defect of Congenital Origin

Two-Dimensional and Color Doppler Assessment of Ventricular Septal Defect of Congenital Origin

Usefulness of color Doppler flow imaging to distinguish ventricular septal defect from acute mitral regurgitation complicating acute myocardial infarction

Several studies have found 2-dimensional echocardiography and conventional spectral Doppler ultrasound useful in the assessment of ventricular septal defect (VSD), but few data exist regarding the usefulness of color Doppler flow imaging in evaluating this problem. Thus, the results of color flow imaging performed in 14 patients who presented with a recent acute myocardial infarction (AMI), hemodynamic instability and a new systolic murmur were evaluated. All patients underwent cardiac catheterization for definitive diagnosis, which proved to be VSD in 7 and acute mitral regurgitation in 7. VSD, identified by turbulent flow traversing the ventricular septum during ventricular systole, was correctly identified in all 7 patients with septal rupture. In the remaining 7 patients with a new murmur after AMI, mitral regurgitation was demonstrated as turbulent systolic flow in the left atrium by both color flow imaging and cine ventriculography. In all 14 patients with new murmurs, color flow imaging was 100% accurate for the presence or absence of VSD. Color flow imaging localized the septal defect to the apical septum (3), inferior septum (3) or both inferior and apical septal regions (1), and was 100% concordant for location compared with cineangiography, surgery and conventional Doppler echocardiographic techniques. Color flow imaging was accurate in identifying the presence and location of VSD complicating AMI, and accurately differentiated VSD from mitral regurgitation. Color flow imaging provides safe, rapid diagnosis of VSD complicating AMI, and may alleviate the need for diagnostic right-sided heart catheterization and preoperative cine ventriculography in these seriouslyill patients.

Assessment by Doppler color flow mapping of ventricular septal defect after acute myocardial infarction

Rupture of the ventricular septum is an uncommon but life-threatening complication of acute myocardial infarction (AMI). It occurs in <1% of infarcts. The noninvasive evaluation of such defects by 2-dimensional echocardiography has been reported. 1 These defects, however, can be difficult to image, particularly after anterior AMI, 2,3 when they are usually located in the apical region. Doppler color flow mapping allows visualization of the shunt flow abnormality and may thus aid in the preoperative assessment of such defects. Color flow mapping has been used intraoperatively to evaluate valve repair 4 and closure of congenital shunt lesions. 5 It may also be a useful tool in assessing the adequacy of repair of ventricular septal rupture after AMI, which continues to carry a high mortality rate despite refinement of surgical technique. We report the use of Doppler color flow mapping for the bedside assessment of ventricular septal defects complicating AMI, and its intraoperative application to assess the effectiveness of surgical repair.

Two-dimensional and color Doppler assessment of ventricular septal defect of congenital origin

Two-dimensional echocardiography and color Doppler examinations were performed in 53 patients with 58 ventricular septal defects (VSD) proven surgically or anatomically. All patients also had angiocardiograms. Two-dimensional echocardiography/color Doppler examination detected all VSDs and correctly categorized the site and extension of VSDs in 50 of 58 (86%). All 40 perimembranous VSDs were diagnosed in the left ventricular outflow tract short-axis plane as an area of discontinuity adjacent to septal tricuspid valve leaflet attachment. Fourteen of 16 VSDs with inlet extension showed initial color flow signals along the septal tricuspid leaflet and along the ventricular septum. Of 23 perimembranous VSDs with outlet extension, 19 had flow signals moving directly toward the right ventricular outflow tract. One perimembranous VSD with trabecular extension showed flow signals directed anterolaterally toward the right ventricular free wall. Eleven of 13 muscular VSDs were similarly categorized correctly by color Doppler as inlet, outlet and trabecular. All 5 doubly committed VSDs were correctly diagnosed as an area of discontinuity adjacent to the pulmonary valve in the short-axis view with flow signals directly moving through VSD into right ventricular outflow and pulmonary artery. Angiography correctly detected all VSDs and correctly classified their site and extension in 45 of 58 (77.5%). It misclassified 8 of 40 perimembranous, 3 of 13 muscular and 2 of 5 doubly committed VSDs. Color Doppler compares favorably with angiocardiography in the detection and localization of VSDs.