Diagnosis Of Congenital Heart Disease Using Two And Three Dimensional Echocardiography

PART ONE: EVALUATION OF ATRIAL SEPTAL DEFECT USINGREAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY:CAMPARISON WITH SURGICAL FINDINGSBACKGROUND.Morphological characteristics of atrial septal defect, including defect size and spatialrelationships between atrial septal defect and neighboring structures are of paramountimportance for the successful deployment of transcatheter septal occluder and surgeryOBJECTIVE:1.To evaluate the value of Three Dimensional Echocardigraphy (3DE) in the diagnosis ofatrial septal defect (ASD) and the measurement of its size by using the surgical findings as thecomparison standard.METHODS:Two-dimensional and real-time three dimensional echocardiography (RT3DE) were performedin 26 patients with atrial septal defect, and the echocardiographic data were compared with thesurgical findings.RESULTS:Significant correlation was found between defect diameter by RT3DE and that measuredduring surgery (r=0.77 p＜0.001).The defect area changed significantly during cardiac cycle. Percentage change in defect sizeduring cardiac cycle ranged from 6%-70%.CONCLUSION:Our study shows that the size and morphology of atrial septal defect obtained with RT3DEcorrelate well with surgical findings. Therefore, RT3DE is feasible and accurate non invasiveimaging tool for assessment of atrial septal size and dynamic changes. PART TWO: EARLY FOLLOW UP OF COMPLICATION AFTERSURGICAL CLOSURE OF ATRIAL SEPTAL DEFECTBACKGROUND.Congenital defect of the atrial septum are common, they account for 7-10% of all cardiacmalformations in childhood.Surgical repair of ASD began in 1948. In 1976 Mills and King reported successful closure ofan occlusion device inserted by a catheter passed into the atrium and later in 1983 by Rashkind.OBJECTIVES:1. Follow-up of early complication and echocardiographic changes after surgical closure ofatrial septal defect.2. To evaluate Preoperative characteristics of the patients with ASD.METHOD:Between June 2007 to October 2008 ,there were sixty patients with ASD, among them thirtyone patients underwent surgical closure of atrial septal defect, out of 31 patients 24 patientswere post operative followed up. Their age ranged from 2yrs to 62 yrs.RESULTS:Preoperative characteristics of ASD patients were as follows: exercise intolerance 65%,recurrent respiratory infection 21%, cyanosis 6.6%, 1^st degree atrioventricular block 3.3%,preoperative pericardial effusion 3.3%. During Follow up period: No death was reported intraoperative, immediate postoperative andsix month post operative. Patients with respiratory complications were 25% and cardiacarrhythmia 4.1%.After surgical closure and six month of follow up period no clinical deterioration wasobserved.Echocardiographic changes:Pericardial effusion was 25.8%, Pre and Postoperative left atrial dimension in children were23.72±4.22 and 25.81±4.44 respectively. In the adult group, Pre and Post operative were30.46±7.64 and 31.61±6.97 respectively. Significant slightly changes were observed for Sixmonth post operative left atrial diameter . however, there were significant changes in rightatrial and ventricular dimension (p＜0.001). Simultaneously, during this period 4.1% of thepatients have persistent right heart dilatation.CONCLUSION.Our study has continue to demonstrate that surgical closure of atrial septal defect can be donewithout or with minimum morbidity and mortality rate , and no major complicationsoccurred during early follow-up in well specialized institutions with longtime experienced likeour institution, however we had minor complications.We also advocates for early closure of secundum ASD to prevent functional changes orcomplication such as pulmonary hypertension which can prevent surgical or devicemanagement of the patients lead to morbidity and mortality. PART THREE:REAL TIME THREE DIMENSIONALECHOCARDIOGRAPHIC ASSESSMENTS OF VENTRICULARSEPTAL DEFECTS: COMPARISON WITH SURGICALMEASUREMENTSBACKGROUNDVentricular septal defect are the most common congenital heart disease in children and adults.Diagnosis of these defects is by 2DE, but 3DE has been now shown to have several advantagesover 2DE particularly for visualization of septal defect ,morphology and rims of the defect,volume measurements and the whole valve evaluationOBJECTIVE: To evaluate the size and morphology of ventricular septal defect usingtransthoracic three dimensional , and two dimensional echocardiography with the surgicalfindings comparison.METHOD:Twenty three patients with ventricular septal defect age ranged from 2 years to 46 years wereexamined using real time three and two dimensional echocardiography before surgery andcompared the size and morphology from surgical findings.RESULTSThe morphological data obtained from three dimensional images correlate with the surgicalfindings.The size measured from three dimensional echocardiography correlate well with the surgicaldata r=0.847 and p＜0.001. And measurements between 2DE and surgical findings were r=0.805; p＜0.001.and the 3D largest diameter compared to 2 D maximum dimension r=0.577p＜0.05. There were slightly significant dynamic changes during cardiac cycle 0.35%-26.50 %.( mean15.88±7.75).CONCLUSIONThe defect size and morphology of VSD measured by real time live three dimensionalechocardiography correlate with surgical findings, therefore RT3DE is accurate forpreoperative surgical planning, post operative follow up and can be used in daily clinicalpractice.