Transoesophageal echocardiographic assessment of primum, secundum and sinus venosus atrial septal defects

We compared the ability of transthoracic and transoesophageal echocardiography to determine the presence and site of an atrial septal defect and associated anomalous pulmonary venous connexions in 13 school age children (aged 5 to 15 years) and 12 adults (aged 25 to 68 years). Transthoracic echocardiography detected atrial septal defects in 12 children and 6 adults. Transoesophageal echocardiography confirmed the position of 16 (13 secundum, 3 primum) of these 18 defects but altered the diagnosis from a secundum defect to a sinus venosus defect in one and from a sinus venosus defect to a high secundum defect in another. In addition to these 18, transoesophageal echocardiography diagnosed a defect in 5 adults (3 secundum and 2 sinus venosus defects) and 1 child (secundum defect). In an adult with inconclusive transthoracic findings, transoesophageal echocardiography enabled clear visualisation of the atrial septum and excluded an atrial septal defect. Transoesophageal echocardiography showed anomalous attachment of a pulmonary vein into the region of a sinus venosus defect (n = 3) but did not show anomalous connexions to the superior caval vein (n = 3) or the inferior caval vein (n = 1). Transoesophageal echocardiography provides a reliable method of diagnosing or excluding an atrial septal defect in patients with inconclusive transthoracic findings and is of particular diagnostic value in sinus venosus defects.     

Detection of sinus venosus atrial septal defect by two-dimensional echocardiography.

In a 4-year period, 10 patients (mean age, 3.6 years) with a superior type sinus venosus atrial septal defect were investigated by two-dimensional echocardiography. The defects were easily visualized in all patients using a long axis vena cava superior-inferior plane with a subcostal approach, while the atrial septum seemed to be intact in the coronal plane conventionally used for atrial septal defects of the primum or secundum type. Additional colour flow mapping, performed in two patients, demonstrated shunting across the depicted defect. In our experience, the modified plane is of great diagnostic value in cases with a sinus venosus defect.     

The sinus venosus type of interatrial communication: its diagnosis by transesophageal echocardiography]

Transthoracic echocardiography has important limitations in the diagnosis of sinus venosus atrial septal defects in adults because of the posterior location of the defect. We review the role of transesophageal echocardiography in the diagnosis of this congenital heart disease in nine patients, as well as in the identification of associated abnormal pulmonary venous connections.     

超声心动图在成人房间隔缺损治疗决策中的作用

目的　探讨超声心动图在成人房间隔缺损(ASD)治疗决策中的作用 ,选择适合的病例进行经皮导管堵闭治疗。方法　本组资料来源于 2 0 0 2年 8月至 2 0 0 3年 8月广东省心血管病研究所 ,12 8例患者经胸超声心动图 (TTE)诊断为继发孔型ASD ,使用TTE筛选和患者同意的 5 2例进行导管堵闭治疗 ,78例患者进行了外科手术治疗。结果　经超声心动图筛选的病例 ,导管介入治疗能有效地关闭 96 %(5 0 /5 2 )的继发孔型ASD ,外科手术修补房间隔缺损的成功率为 10 0 % ,超声心动图显示的房间隔缺损分型与外科术中分型的差异无显著的统计学意义 (P >0 0 5 )。结论　经胸超声心动图能准确的显示成人ASD解剖变异和确定分型 ,经皮导管介入治疗能成功地堵闭绝大多数经超声心动图筛选的患者     

The value of transesophageal echocardiography in transcatheter closure of atrial septal defects in the oval fossa using the Amplatzer septal occluder

BACKGROUND: From January, 1997, as part of an international multicentric trial, we have been closing small-to-moderate atrial septal defects within the oval fossa using the Amplatzer Septal Occluder (ASO, AGA Medical). METHODS: All patients with defects within the oval fossa deemed potentially suitable for transcatheter closure were investigated by transesophageal echocardiography with the aim of gaining extra information that might alter the decision to use the device to close the defect. Views were obtained in transverse and longitudinal planes, permitting measurements of the diameter of the defect, and its distance from the atrioventricular valves, coronary sinus, and pulmonary veins. Additionally, we sought to identify multiple defects, and to exclude sinus venosus defects. RESULTS: Of 56 patients with left-to-right shunts, 41 (73.2%) were deemed suitable for closure with the Amplatzer Septal Occluder. All underwent the procedure successfully, with no complications. This includes 5 patients with multiple small defects that were sufficiently close to the main defect to be closed with a single device. Only two of these had been detected on the transthoracic study. In the remaining 15 of 56 patients, transcatheter closure was deemed unsuitable. In 9 patients, this was due to the limitation of the size of the device available during the period of study, this representing a relative contraindication. In the remaining 6 (10.7%), transcatheter closure was not performed because multiple defects were too far apart to be closed with a single device in 3 patients, two patients were noted to have a sinus venosus defect, and another was noted to have anomalous connection of the right upper pulmonary vein to the right atrium. Excluding patients contraindicated due to the size of the defect alone, transesophageal echocardiography provided extra information in one-tenth of our patients, which altered the decision regarding management. CONCLUSION: Transesophageal echocardiography is indispensable in the evaluation of patients undergoing transcatheter closure of atrial septal defect.     

Diagnosis of the sinus venosus defect by echocardiography and angiocardiography.

A retrospective analysis of forty five cases of sinus venosus defect was done to compare the ability of transthoracic echocardiography, transesophageal echocardiography and cineangiography in diagnosing this lesion. Left atrial and superior vena cava angiography delineated sinus venosus defect accurately in all the 45 cases (100%). Transthoracic cross-sectional echocardiography combined with colour flow mapping could visualize this defect in 28 out of 45 cases (62.2%) and proved inferior to transesophgeal technique which diagnosed the defect in all the 8 cases (100%) studied. An anomalous venous connection associated with sinus venosus defect was best diagnosed at cardiac catheterization although transesophgeal technique seems promising.     

Real Time Three‐Dimensional Transesophageal Echocardiographic Evaluation of a Sinus Venosus Atrial Septal Defect

We present a case of a 65‐year‐old man who presented with atrial flutter and dilation of right heart was noted on transthoracic echocardiography. Transesophageal echocardiography revealed a large sinus venosus atrial septal defect close to superior vena cava and anomalous connection of right superior pulmonary vein. Additionally, real time three‐dimensional transesophageal echocardiography provided superior spatial details and demonstrated the size, location of the defect and its spatial relationship to the surrounding structures. Patient underwent successful surgical repair. (Echocardiography 2011;28:E82‐E84)     

The improved yield of transesophageal echocardiography over transthoracic echocardiography in patients with neurological events is largely due to the detection of aortic protruding atheromas

It is important to determine what, if any, the added contribution of transesophageal echocardiography is to the evaluation of patients with unexplained strokes and transient ischemic attacks. Transesophageal echocardiography was performed in 283 consecutive patients over an 8-month period. The reason for referral in 63 of these patients was unexplained stroke or transient ischemic attack. These 63 studies were evaluated for the presence of lesions that could be etiologic in these patients, including protruding aortic atheromas, spontaneous echo contrast, atrial septal aneurysms, and atrial clots. The transesophageal and transthoracic techniques were compared. The main finding was that there were 23 abnormal findings that might have been responsible for stroke or transient ischemic attacks seen on transesophageal echocardiography, which were not visualized on transthoracic echocardiography. Transthoracic echocardiography was false negative in 19 (30%) of 63 patients. None of the protruding aortic arch atheromas seen on transesophageal echocardiography were diagnosed with transthoracic echocardiography. Transesophageal echocardiography is indicated in the evaluation of patients with unexplained strokes and transient ischemic attacks, and the added yield of this technique is largely due to the finding of protruding aortic arch atheromas.     

Surgical evaluation of transthoracic tridimensional echocardiography in the anatomic study of atrial septal defect]

The closure of atrial septal defects by interventional catheterisation requires an accurate assessment of their morphology and anatomical relationships. This study evaluated transthoracic three-dimensional echocardiography for the selection of atrial septal defects accessible to an occlusive prosthesis. The transthoracic three-dimensional echocardiographic measurements of 17 patients (4 to 55 years) with ostium secundum atrial septal defects were compared with those of the surgeon in a prospective study. The maximal diameters of the defect, the height of the interatrial septum, the distances to the superior vena cava (postero-superior border) and inferior vena cava (postero-inferior border), to the coronary sinus and the tricuspid valve were measured as a reconstruction of the interatrial septum seen from the right atrium. The aortic border was measured from a three-dimensional view from the left atrium. Thirteen of the 17 investigations (76%) were exploitable. The diameters of the defect varied during the cardiac cycle (p = 0.0002). Ther correlations between the surgical and echocardiographic measurements varied from 0.82 for the maximal diameter to 0.6 for the postero-inferior limits. Three-dimensional echocardiography is capable of detecting all the contra-indications of an occlusive prosthesis: 2 inadequate postero-inferior and 1 inadequate aortic borders, 9 maximal diameters which were too large, 3 insufficiently high atrial septa, 1 double atrial septal defect. The coronary sinus was only visualised in 1 case. Transthoracic three-dimensional echocardiography is a non-invasive technique capable of improving the selection of atrial septal defects for interventional closure. The transoesophageal approach should be reserved for candidates selected by the transthoracic investigation for the detection of small structures (coronary sinus) and when the transthoracic window is poor.     

The usefulness of transesophageal echocardiography during percutaneous balloon mitral valvulotomy]

The purpose of this study is to report the experience at Instituto de Cardiología de México with transesophageal echocardiography during percutaneous mitral valvulotomy and to compare its utility with transthoracic echocardiography. Sixteen patients with isolated or predominant mitral stenosis were examined and underwent percutaneous mitral valvulotomy with a single balloon catheter (Inoue [correction of Ionue] technique). Transthoracic echocardiography was done in all cases previous to the procedure. The procedure orientation was done with transesophageal in thirteen patients and with. Transthoracic echocardiography in the other three. The results were successful in all cases. Transesophageal echocardiography was more useful in the initial evaluation in patients with poor transthoracic windows, in those with clinical and/or transthoracic evidence of atrial thrombosis, as well as in procedure orientation, spontaneous contrast detection, mitral regurgitation and atrial septal defect evaluation after the procedure. Transesophageal echocardiography is superior to transthoracic technique in procedure orientation, early evaluation of results and potential complications. However, its practical utility is limited and its routine use is not recommended.     

Mitral Stenosis, Sinus Venosus Atrial Septal Defect, and Partial Anomalous Pulmonary Venous Return

We describe a 42-year-old man with rheumatic mitral stenosis, sinus venosus atrial septal defect, and anomalous drainage of the right upper pulmonary vein to the superior vena cava. Transthoracic echocardiography (TTE) failed to identify the atrial septal defect and the partial anomalous pulmonary venous return. Transesophageal echocardiography (TEE), using a multiplane probe, was useful in delineating the abnormalities. To our knowledge, this is the first reported patient with rheumatic mitral stenosis and sinus venosus defect.     

Assessment of atrial pathologies in children using transesophageal echocardiography]

OBJECTIVE: Transesophageal echocardiography (TEE) is indicated for suspected atrial septal pathology and for monitoring of interventional procedures such as an atrial septal defect (ASD) closure during cardiac catheterization. Transesophageal echocardiography also helps to demonstrate postoperative complications and residual defects of complex congenital cardiac anomalies. METHODS: Transesophageal echocardiography was performed in 112 pediatric patients with or suspected atrial pathology at our institution between 1999-2002, using the standard techniques. The mean age was 8.7+/-4.2 years. RESULTS: In 45 of 112 children the suspected atrial defects were confirmed with the TEE. Patent foramen ovale was correctly predicted in 13.4% of patients by TEE, but only in 8.7% of patients by echocardiography. Multiple ASD's were correctly defined in 4.1%, and high venosus defects were documented in 6.1% of children by the TEE. We used TEE in 13% of patients for detecting atrial vegetations in patients with possible endocarditis, and evaluation of the postoperative care of atrial surgery such as Fontan or Senning operations and total correction of abnormal pulmonary venous return. Successful transcatheter closure of 7 ASD's was accomplished under TEE guidance. CONCLUSION: Transesophageal echocardiography allows a much more detailed evaluation of atrial morphology than transthoracic echocardiography even in infants. Transesophageal echocardiography is also indicated during interventional procedures and postoperative evaluation of the atrial pathology.     

Identification of atrial septal defects by cross-sectional contrast echocardiography.

Cross-sectional echocardiography, combined with injections of contrast into peripheral arm veins, has been used to study 15 patients with atrial septal defects and 10 patients with an intact interatrial septum. Of 11 patients with ostium secundum or sinus venosus atrial septal defects and left-to-right shunts a defect could be visualised in all, and in eight some degree of transfer of contrast from right atrium to left atrium was seen. In three of four patients with a dominant right-to-left shunt a defect was seen and in all there was free transfer of contrast from right atrium to left atrium. Though there may be variable loss of echoes in the septal image in patients with an intact interatrial septum, in general no fixed defect is seen an there is no transfer of contrast from right atrium to left atrium. This is a potentially valuable technique in the assessment of patients in whom an atrial septal defect is suspected.     

Mitral Stenosis, Sinus Venosus Atrial Septal Defect, and Partial Anomalous Pulmonary Venous Return: Diagnosis by Multiplane Transesophageal Echocardiography

We describe a 42-year-old man with rheumatic mitral stenosis, sinus venosus atrial septal defect, and anomalous drainage of the right upper pulmonary vein to the superior vena cava. Transthoracic echocardiography (TTE) failed to identify the atrial septal defect and the partial anomalous pulmonary venous return. Transesophageal echocardiography (TEE), using a multiplane probe, was useful in delineating the abnormalities. To our knowledge, this is the first reported patient with rheumatic mitral stenosis and sinus venosus defect. (ECHOCARDIOGRAPHY, Volume 13, November 1996)     

Direct visualization of ruptured chordae tendineae by transesophageal two-dimensional echocardiography

To determine the value of transesophageal echocardiography in the detection of ruptured chordae tendineae, 28 patients who had surgical therapy for pure mitral regurgitation were evaluated prospectively by conventional transthoracic and transesophageal two-dimensional echocardiography. Seventeen patients (Group I) had ruptured chordae tendineae and 11 (Group II) had intact chordae tendineae. Transthoracic echocardiography detected ruptured chordae tendineae in 6 patients from Group I (sensitivity 35%) and flail leaflets in 11 patients from Group I (sensitivity 65%). Transesophageal echocardiography disclosed ruptured chordae tendineae in all 17 Group I patients (sensitivity 100%); the sensitivity was significantly higher than that of transthoracic echocardiography. No abnormal chordal echoes were visualized in any patient from Group II by either transthoracic or transesophageal echocardiography (specificity 100%). Transesophageal echocardiography is a highly sensitive method for detecting ruptured chordae tendineae and is superior to transthoracic echocardiography in establishing its diagnosis.     

Echocardiographic guidance during placement of the buttoned double-disk device for atrial septal defect closure

The usefulness of two-dimensional and Doppler echocardiography during buttoned double-disk device closure of an atrial septal defect was evaluated in 20 consecutive patients at the time of interventional catheterization. Transesophageal echocardiography was used in 11 patients (ages 5 to 62 years, weights 20 to 91 kg). Because of the size of the available transesophageal echo probe, transthoracic echocardiography was used in the remaining 9 patients (ages 4 to 5.5 years, weights 14 to 21 kg). In the transesophageal echo group, 1 patient was found to have no atrial septal defect despite a previous diagnosis by transthoracic echocardiography, 3 patients had atrial septal defects too large for closure despite attempts in 2, and 7 patients had transesophageal echo guided device placement. All of these 7 patients had small residual shunts by color Doppler, 2 had unusual arm positions, and 2 had surgical removal of the device due to embolization to the pulmonary artery in 1 and failure to obtain close approximation of the occluder and counteroccluder in 1. In the transthoracic echo group, 2 patients had atrial septal defects too large for closure, 1 patient had no femoral venous access, and 6 patients had transthoracic echo guided device placement. All of these 6 patients had small residual shunts by color Doppler and 3 of the 6 had unusual arm positions. For atrial septal defect sizing, transesophageal echo measurements correlated with catheter balloon size more closely than did transthoracic echo measurements (r 2 = 0.97 vs 0.86).(ABSTRACT TRUNCATED AT 250 WORDS)     

Is routine preoperative cardiac catheterization necessary before repair of secundum and sinus venosus atrial septal defects?

Between January 1976 and July 1983, 217 patients with atrial septal defect underwent surgical repair at Children's Hospital. Thirty with a primum atrial septal defect and 26 who underwent cardiac catheterization elsewhere before being seen were excluded from analysis. Of the 161 remaining patients, 52 (31%) underwent preoperative cardiac catheterization, 38 because the physical examination was considered atypical for a secundum atrial septal defect and 14 because of a preexisting routine indication. One hundred nine (69%) underwent surgery without catheterization, with the attending cardiologist relying on clinical examination alone in 5, additional technetium radionuclide angiocardiography in 5, M-mode echocardiography in 13 and two-dimensional echocardiography in 43; both M-mode echocardiography and radionuclide angiography were performed in 24 and two-dimensional echocardiography and radionuclide angiography in 19. Since 1976, there has been a trend toward a reduction in the use of catheterization and use of one rather than two noninvasive or semiinvasive techniques for the detection of atrial defects. Of the 52 patients who underwent catheterization, the correct anatomic diagnosis was made before catheterization in 47 (90%). Two patients with a sinus venosus defect and one each with a sinus venosus defect plus partial anomalous pulmonary venous connection, partial anomalous pulmonary venous connection without an atrial septal defect and a sinoseptal defect were missed. Of 109 patients without catheterization, a correct morphologic diagnosis was made before surgery in 92 (84%). Nine patients with a sinus venosus defect, three with sinus venous defect and partial anomolous pulmonary venous connection, four with partial anomalous pulmonary venous return without an atrial septal defect and one with a secundum defect were incorrectly diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)     

单纯经食道超声心动图引导下经皮房间隔缺损封堵术的疗效分析

分析单纯经食管超声心动图引导下经皮行房间隔缺损封堵术的临床资料,评价方法的安全性和有效性。 方法：回顾性分析2017年6月至2018年6月采用经食道超声心动图引导经皮房间隔缺损封堵术患者共16例,操作均在普通手术室进行,单纯采用经食道超声心动图引导,在全身麻醉下,经股静脉穿刺封堵房间隔缺损。食道超声全程监测封堵全过程并评估手术效果。所有患者均在术后1个月、6个月接受经胸超声心动图复查。结果 共14例患者封堵成功,1例患者术中封堵器释放后超声心动图提示封堵器靠近下腔边缘存在大量分流,封堵器收入鞘管再次释放后仍存在残余分流,调整为经右胸小切口成功释放封堵伞,另一例术后7日出院前复查超声心动图提示封堵器脱落位于右心室内,再次行房间隔缺损修补术。随访过程中均未见明显并发症。结论 经食道超声心动图引导下可以完成大多数房间隔缺损经皮封堵术,避免放射线可能引起伤害,取得良好的临床应用效果。     

Real time three‐dimensional transesophageal echocardiography imaging of crescent‐shaped superior sinus venosus atrial septal defect

Multi‐imaging modalities should be considered in patients with atrial septal defects (ASDs) in which the degree of right ventricular enlargement is not fully explained by the small size of ASD found on conventional transthoracic echocardiography. We report a case of crescent‐shaped superior sinus venosus ASD discriminated using real‐time three‐dimensional transesophageal echocardiography. MDCT confirmed its relationship with the superior vena cava and the absence of combined anomalies, such as the pulmonary venous return anomaly.     

Incidence of secondary pulmonary hypertension in adults with atrial septal or sinus venosus defects

OBJECTIVE: To examine the incidence of raised pulmonary artery pressure and resistance in adults with isolated atrial septal defect within the oval fossa (so called secundum defect) or sinus venosus defect. DESIGN: A historical, retrospective, unrandomised study. SETTING: A tertiary referral centre. METHODS: Cardiac catheterisation was performed in all patients, with measurement of pulmonary artery pressure and resistance. Pulmonary to systemic flow ratio was calculated using the Fick principle. Pulmonary hypertension was defined as mean pulmonary artery pressure > 30 mm Hg, and increased resistance as an Rp/Rs ratio > 0.3. PATIENTS: All patients with a secundum atrial septal or sinus venosus defect who presented between July 1988 and December 1997 were enrolled in the study. RESULTS: Pulmonary artery pressure and resistance in the patients with sinus venosus defect (n = 31) was higher than in patients with atrial septal defect (n = 138). Pulmonary hypertension was present in 26% of patients with sinus venosus and in 9% of patients with atrial septal defect. The incidence of raised pulmonary vascular resistance was 16% in patients with sinus venosus and 4% in patients with atrial septal defect. The increase in resistance occurred at a younger age in sinus venosus defect than in atrial septal defect. CONCLUSIONS: Patients with sinus venosus defect have higher pulmonary pressures and resistances and develop these complications at younger age than patients with atrial septal defects. Thus they should be managed differently than patients with "simple" atrial septal defects.