| Background: Atrial septal defect(ASD) is the most common congenital heart diseases (CHD) .Exactly assessment of the site, shape, size and anatomic relation of the defect with its surrounding structures is essential for the clinical management of the patient. At present, traditional two dimensional echocardiography (2DE) is the most widely used non-invasive method for the diagnosis of ASD combining with color Doppler flow imaging(CDFI). However, limited by the imaging principle, 2DE could only display certain planar characters of the defect within relatively fixed 2-dimensional view and lacks the ability to display the entire shape of the atrial septal defects and cannot quantify them accurately. Real-time three-dimensional echocardiography(RT-3DE) enables dynamic three-dimensional visualization and quantification of ASD in real-time. It has more advantage than 2DE in diagnosis of ASD.Objective: To observe and compare ultrasonic images of RT-3DE and 2DE in ASD. To compare the size of ASD measured by 2DE with the results measured by RT-3DE and surgery. To explore the clinical value of RT-3DE in assessment the morphology and the size of ASD.Methods: Between October 2007 to October 2008, thirty patients with ASD undergoing surgical treatment in Shanxi Cardiovascular Hospital were enrolled in the study. All patients were examined with conventional echocardiography and RT-3DE. The ultrasonic images of ASD acquired by 2DE were compared with that acquired by RT-3DE including the shape, site, its relationship with the neighboring structures and the dynamic change during cardiac cycle. The size of the defect measured by RT-3DE using Q-Lab5.0 3D work-station were compared with the results measured by 2DE and surgery results.Results: (1) 2DE and RT-3DE examinations were successfully accomplished in all thirty patients with ASD. (2) Complete visualization of the location, shape, its relationship with the neighboring structures and dynamic change of the defect was attained from either the left-sided or right-sided point of view. RT-3DE provided more diagnostic information than 2DE. (3) The correlation ( r=0.75, Y = 0.53X + 8.44, P < 0.05) between 2D largest diameter[(2.36±0.76)cm] and 3D the largest diameter[(2.81±0.94)cm] was better than that between 2D largest diameter and 3D maximum area[(6.70±2.38) cm2] ( r=0.73, Y = 0.23X +1.24, P < 0.05). By comparing 2D largest diameter and 3D largest diameter with surgical findings [(2.78±0.95)cm]respectively,the results was r=0.70(Y = 0.53X + 8.40, P < 0.05) vs r=0.98(Y = 1.01X + 0.05, P < 0.05). The 3D maximum area had good correlation with surgery results [(4.48±2. 40)cm2] (r= 0.89). Conclusions: The stereoscopic views of ASD can be displayed in real time by RT-3DE. Compared with 2DE, RT-3DE can provide additional spatial information of the site, shape, adjacent structure of the defect. In quantifying the defect ,although 2D diameter showed positive correlation with 3D data,the degree of correlation was not so good. Compared with surgical findings, 3D data had a better correlation than 2D diameter.It confirmed that RT-3DE has the advantage of not only displaying the entire shape of the defect and its spatial relationship with its neighboring structures, but also accurately quantifying the defect. These results demonstrate that RT-3DE is helpful in providing more detailed noninvasive diagnosis and preoperative planning.
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