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Transthoracic 3-dimensional echocardiography in the assessment of subaortic stenosis due to a restrictive ventricular septal defect in double inlet left ventricle with discordant ventriculoarterial connections

Published online by Cambridge University Press:  19 August 2008

Michael Vogel ,
S. Yen Ho ,
Robert H. Anderson  and
Andrew N. Redingtont
Michael Vogel*
Affiliation:
Department Congenital Heart Disease, Deutsches Herzzentrum, Berlin, Germany
S. Yen Ho
Affiliation:
National Heart and Lung Institute, Imperial College School of Medicine, London, UK
Robert H. Anderson
Affiliation:
National Heart and Lung Institute, Imperial College School of Medicine, London, UK
Andrew N. Redingtont
Affiliation:
Great Ormond Street Hospital, London, UK
*
Prof. M. Vogel, Deutsches Herzzentrum, Postfach 650505, D-13305 Berlin, Germany. Tel: +49 30 4593 2823; Fax: +49 30 4593 2826; E-mail: mvogel@dhzb.de
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Abstract

Abstract

To evaluate the accuracy and clinical utility of three-dimensional echocardiography in the assessment of the size and shape of the ventricular septal defect in double inlet left ventricle.

Methods

We validated the technique in an autopsy study, and then performed a clinical investigation. Six autopsied hearts were immersed in a waterbath and examined with 3-dimensional echocardiography. We identified the cross-section within the dataset which optimally displayed the ventricular septal defect “en face”, and compared its smallest and largest diameters, as well as its area. The ventricular septal defect was then filled with a silicone sealant and a section prepared for direct measurement. In patients, we measured the diameters and area of the ventricular septal defect in endsystole nad computed the aortic valvar area in endsystole from the cross-section showing the aortic valve “en face”. Ten patients with double inlet left ventricle, aged between 2 and 15 years, were studied using rotational or parallel scanning. All patients had undergone banding of the pulmonary trunk at a mean age of 7 (3–36) days, usually at the time of repair of the coarctation. Two patients had undergone surgical enlargement of the ventricular septal defect prior to echocardiographic examination.

Results

The correlation between the areas of the ventricular septal defect in the specimens measured directly and by 3-dimensional echocardiography was r=0.98, with limits of agreement between −0.1– 0.08 cm2. In the patients, the area of the defect was measured as 3.9±2 cm2, whereas the aortic valvar area was 2.6±0.9 cm2. The ratio between the areas was 1.5 (0.5–2.3). Three patients with areas of the ventricular septal defect smaller than those of the aortic valve had resting Doppler gradients between double inlet left ventricle and the aorta of 16, 20 and 30 mm Hgs, respectively.

Conclusions

3-dimensional echocardiography provides accurate assessment of the area of the ventricular septal defect in double inlet left ventricle, and is helpful in identifying patients with subaortic stenosis caused by restrictive defects.

Keywords

three-dimensional echocardiographydouble inlet left ventriclesubaortic obstruction
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 6 , November 1999 , pp. 549 - 555
Copyright
Copyright © Cambridge University Press 1999

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References

1.Girod, DA, Lima, RC, Anderson, RH, Ho, SY, Rigby, ML, Quagebeuer, J. Double inlet ventricle : morphologic analysis and surgical implications in 32 cases. J Thorac Cardiovasc Surg 1984;88: 590–600CrossRefGoogle ScholarPubMed
2.Shiraishi, H, Silverman, NH. Echocardiographic spectrum of double inlet ventricle: Evaluation of the interventricular communication. J Am Coll Cardiol 1990;15:1401–1408CrossRefGoogle ScholarPubMed
3.Freedom, RM, Benson, LN, Smallhorn, JF, Williams, WG, Trusler, GA, Rowe, RD. Subaortic stenosis, the univentricular heart, and banding of the pulmonary artery: an analysis of the courses of 43 patients with univentricular heart palliated by pulmonary artery banding. Circulation 1986; 73:758–764CrossRefGoogle ScholarPubMed
4.van, Son JAM, Falk, V, Walther, T, Diegeler, A, Schneider, P, Haas, GS, Mohr, FW. Instantaneous Subaortic outflow obstruction after volume reduction in hearts with univentricular atrioventricular connection and discordant ventriculoarterial connection. Mayo Clin Proc 1997; 72: 309–314CrossRefGoogle Scholar
5.Anderson, RH, Penkoske, PA, Zuberbuhler, JR. Variable morphology of ventricular septal defect in double inlet left ventricle. Am J Cardiol 1985;55:1560–1565CrossRefGoogle ScholarPubMed
6.Rivera, JM, Siu, SC, Handschuhmacher, MD, Lethor, JP, Guerrero, JL, Vlahakes, GJ, Mitchell, JD, Weyman, AE, King, ME, Levine, RA. Three-dimensional reconstruction of ventricular septal defects: validation studies and in vivo feasibility. J Am Coll Cardiol 1994;23:201–208CrossRefGoogle ScholarPubMed
7.Vogel, M, Lösch, S. Dynamic three-dimensional echocardiography with a computed imaging probe (Echo-CT). Initial clinical experience with transthoracic application in infants and children with congenital heart defects. Br Heart J 1994; 71:462–467CrossRefGoogle Scholar
8.Marx, GR, Fulton, DR, Pandian, NG, Vogel, M, Cao, QL, Ludomirsky, A, Delabays, A, Sugeng, L, Klas, B. Delineation of site, relative size and dynamic geometry of atrial septal defects by real-time three-dimensional echocardiography. J Am Coll Cardiol 1995; 25: 482–490CrossRefGoogle ScholarPubMed
9.Vogel, M, Ho, SY , Bühlmeyer, K, Anderson, RH. Assessment of congenital heart defects by dynamic three-dimensional echocardiography: Methods of data acquisition and clinical utility. Acta Paediatrica 1995; Supplement 410: 34–39CrossRefGoogle Scholar
10.Vogel, M, Ho, SY, Anderson, RH. Comparison of three-dimensional echocardiographic findings with anatomic specimens of various congenitally malformed hearts. Br Heart J 1995; 73: 566–570CrossRefGoogle ScholarPubMed
11.Bland, M, Altman, DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986,1:307–310CrossRefGoogle ScholarPubMed
12.Matitiau, A, Geva, T, Colan, SD, Sluysmans, T, Parness, IA, Spevak, PJ, van der Velde, M, Mayer, JE Jr, Sanders, SPBulboventricular foramen size in infants with double inlet left ventricle or tricuspid atresia with transposed great arteries: Influence on initial palliative operation and rate of growth. J Am Coll Cardiol 1992; 19:142–148CrossRefGoogle ScholarPubMed
13.Somerville, J, Becu, L, Ross, D. Common ventricle with acquired Subaortic obstruction. AmJ Cardiol 1974;34:206–214CrossRefGoogle ScholarPubMed
14.Franklin, RC, Sullivan, ID, Anderson, RH, Shinebourne, EA, Deanfield, JE. Is banding of the pulmonary trunk obsolete for infants with tricuspid atresia and double inlet ventricle with a discordant ventriculoarterial connection ? Role of aortic arch obstruction and Subaortic stenosis. J Am Coll Cardiol 1990;16:1455–1464CrossRefGoogle ScholarPubMed
15.Razzouk, AJ, Freedom, RM, Cohen, AJ, Williams, WG, Trusler, GA, Coles, JG, Burrows, PE, Rebeyka, IM: The recognition, identification of morphologic substrate, and treatment of Subaortic stenosis after Fontan operation. J Thorac Cardiovasc Surg 1992; 104:938–944CrossRefGoogle ScholarPubMed
16.Donofrio, MT, Jacobs, ML, Norwod, WI, Rychik, J. Early changes in ventricular septal defect size and ventricular geometry in the single left ventricle after volume-unloading surgery. J Am Coll Cardiol 1995;26:1008–1015CrossRefGoogle ScholarPubMed
17.Penkoske, PA, Freedom, RM, Williams, WG, Trusler, GA, Rowe, RD. Surgical palliation of Subaortic stenosis in the univentricular heart. J Thorac Cardiovasc Surg 1984; 87:767–781CrossRefGoogle ScholarPubMed
18.Cheung, HC, Lincoln, C, Anderson, RH, Ho, SY, Shinebourne, EA, Pallides, S, Rigby, ML. Options for surgical repair in hearts with univentricular atrioventricular connection and Subaortic stenosis. J Thorac Cardiovasc Surg 1990: 100;672–681CrossRefGoogle ScholarPubMed
19.Karl, TR, Watterson, KG, Sano, S, Mee, RB. Operations for subaortic stenosis in univentricular hearts. Ann Thorac Surg 1991; 52:420–427CrossRefGoogle ScholarPubMed
20.Freedom, RM, Dische, R, Rowe, RD. Pathologic anatomy of subaortic stenosis and atresia in the first year of life. Am J Cardiol 1977;39:1035–1044CrossRefGoogle ScholarPubMed
21.Freedom, RM, Rowe, RD. Morphological and topographical variations of the outlet chamber in complex congenital heart disease: an angiographic study. Cath Cardiovasc Diagn 1978;4:345–371CrossRefGoogle Scholar
22.Franke, A, Kühl, HP, Rulands, D, Jansen, C, Erena, C, Grabitz, RG, Däbritz, S, Messmer, BJ, Flachskampf, FA, Hanrath, P. Quantitative analysis of morphology of secundum-type atrial septal defects and their dynamic change using transoesophageal three-dimensional echocardiography. Circulation 1997;96 (Supp II): II–323–327Google Scholar
23.Magni, G, Cao, QL, Sugeng, L, Delabays, A, Marx, GR, Ludomirsky, A, Vogel, M, Pandian, NG. Volume rendered three-dimensional echocardiographic determination of the size, shape and position of atrial septal defects: Validation in an in-vitro model. Am Heart J 1996; 132:376–381CrossRefGoogle ScholarPubMed
24.Acar, P, Maunoury, C, Antonietti, T, Bonnet, D, Sidi, D, Kachaner, J. Left ventricular ejection fraction in children measured by three-dimensional echocardiogaphy using a new transthoracic integrated 3D-probe. A comparison with equilibrium radionuclide angiogaphy. Eur Heart J 1998; 19:183–1588CrossRefGoogle Scholar
25.Ota, T, Fleishman, CE, Strub, M, Stetten, G, Ohazama, CJ, von, Ramm OT, Kisslo, J. Real-time, three-dimensional echocardiogrphy: Feasibility of dynamic right ventricular volume measurement with saline contrast. Am Heart J 1999; 137: 958–967CrossRefGoogle Scholar
26.Kasprzak, JD, Nosir, YF, Dall'Agata, A, Elhendy, A, Taams, M, Ten, Cate FJ, Roelandt, JR. Quantitation of the aortic valve area in three-dimenisonal echocardiographic data sets: analysis of orifice overestimation resulting from suboptimal cut-plane selection. Am Heart J 1998;135:995–1003CrossRefGoogle Scholar