经胸实时三维超声心动图对房室间隔缺损的诊断价值

目的探讨经胸实时三维超声心动图对房室间隔缺损的诊断价值。方法回顾性分析2009年6月至2011年11月间首次二维超声心动图检查诊断为房室间隔缺损的81例患者,再做经胸实时三维超声心动图补充检查。81例房室间隔缺损均经手术证实。结果经胸实时三维超声心动图较二维超声心动图能提供更丰富的病变信息。结论经胸实时三维超声心动图能对房室间隔缺损诊断作更好的补充,对房室间隔缺损的术前评估及术后随访有重要的临床意义。     

Usefulness of live/real time three-dimensional transthoracic echocardiography in the assessment of atrioventricular septal defects

We studied nine patients (five newborns and infants, two children, and two adults) with atrioventricular septal defects (four complete, one intermediate, and four partial) utilizing live/real time three-dimensional transthoracic echocardiography (3DTTE) and a 4-MHz matrix array transducer. In all patients, 3DTTE provided additional morphological and/or functional information as compared to standard two-dimensional transthoracic echocardiography (2DTTE). 3DTTE may be a useful supplement to 2DTTE in the assessment of atrioventricular septal defects.     

Ventricular septal rupture and mitral regurgitation caused by trauma

We present a young patient with traumatic septal rupture following traffic accident in whom transthoracic echocardiography allowed comprehensive noninvasive assessment of location and size of the septal defect and structure atrioventricular valve apparatus.     

Three-dimensional transesophageal echocardiographic demonstration of anatomical defects in AV septal defect patients presenting for reoperation

We present two- and three-dimensional transesophageal echocardiographic findings of two adult patients who presented for reoperation after previous repair of a partial atrioventricular (AV) septal defect. Both patients had a cleft in the left AV valve with severe regurgitation. One patient had an additional 10 x 5 mm defect connecting the left ventricle to the right atrium through the AV junction. Three-dimensional echocardiography was superior to two-dimensional echocardiography in comprehensively delineating the anatomical defects in the left AV valve and the AV junction.     

Live/Real Time Three-Dimensional Transthoracic Echocardiographic Findings in an Adult with Complete Atrioventricular Septal Defect

Live/real time three-dimensional transthoracic echocardiography provided incremental value over two-dimensional transthoracic echocardiography in an adult patient with complete atrioventricular (AV) septal defect by (1) making a confident diagnosis of Rastelli type A defect, (2) providing en face view of all the five leaflets of the common AV valve, (3) diagnosing left ventricle to right atrial shunt, and (4) permitting more accurate quantitative assessment of regurgitant lesions. (Echocardiography 2010;27:87-90)     

Percutaneous edge‐to‐edge repair for common atrioventricular valve regurgitation in a patient with heterotaxy syndrome,single ventricle physiology,and unbalanced atrioventricular septal defect

Congenital heart disease patients, specifically with unbalanced atrioventricular septal defects and common atrioventricular valves requiring single ventricle palliation, have substantial morbidity and mortality. Atrioventricular valve regurgitation (AVVR) is associated with poor outcomes in single ventricle patients, and many of them require surgical treatment of AVVR in their lifetimes. We describe a unique case of transcatheter edge‐to‐edge valve repair using the MitraClip system (Abbott, Chicago, IL) in a single ventricle patient with severe common AVVR.     

经胸房间隔缺损堵闭术对房室瓣反流的影响

目的探讨经胸房间隔缺损封堵术对房室瓣反流的影响。方法回顾性分析2002年1月至2011年3月在南方医科大学珠江医院经胸微创房间隔缺损堵闭术患者的临床资料,其中资料完全者43例,40例在食道超声、2例在经胸超声辅助下行房间隔缺损堵闭术。患者术前、术后1个月及6个月经超声心动图检查,观察心脏各指标的变化和房室瓣反流程度。结果41例手术成功,手术成功率95．3％（41／43）;1例术中改为右侧开胸小切口体外循环下房间隔缺损修补术,1例术中并发心搏骤停。1例术后并发肾功能衰竭：12例术后即时有少量残余漏,1个月后超声复查消失。术后超声随访显示：右心室、右心房直径较前缩小,左心室直径较前增大,肺动脉瓣血流速度明显降低,差异有统计学意义（P〈0．05）;室间隔厚度、二尖瓣血流速度、主动脉瓣血流速度无明显改变,差异无统计学意义（P〉0．05）。房间隔缺损堵闭术后1个月、6个月,二尖瓣瓣膜反流程度较术前加重,差异有统计学意义（平均秩次：2．01VS．2．17vs1．77,x2=10．78,P=0．04）;而三尖瓣的瓣膜反流程度术前与术后1个月、6个月比较,差异无统计学意义（平均秩次：1．88vs2．11US．2．01,X2=4．23,P=0．134）。结论房间隔缺损封堵术后,可引起二尖瓣反流程度的加重,但对三尖瓣的反流程度近期影响不明显;二尖瓣中度以上或三尖瓣重度反流的患者或不适宜行单纯房间缺损封堵术。     

Multiplane Transesophageal Echocardiographic Evaluation of Defects of the Atrioventricular Septum: The Crux of the Matter

The availability of multiplane transesophageal probes has dramatically facilitated visualization of complex cardiac anatomy, with full dynamic tracking of anatomic contiguity. This report describes the unique applicability of multiplane transesophageal echocardiography (TEE) for visualization and assessment of a spectrum of congenital cardiac defects involving the cardiac crux, including the atrioventricular septum, inlet muscular septum, and the atrioventricular valves. With further evolution and progressive miniaturization of these probes, the use of this echocardiographic modality will hopefully encroach into the young infant age range, permitting enhanced preoperative and perioperative depiction of complex congenital cardiac anatomy.     

Double aortic arch, tetralogy of Fallot with pulmonary atresia and atrioventricular septal defect.

A double aortic arch is usually an isolated abnormality. We describe a case with a previously undescribed combination of tetralogy of Fallot with pulmonary atresia, complete atrioventricular septal defect, and left patent arterial duct in association with a double aortic arch. A complete diagnosis was made by echocardiography. Meticulous suprasternal echocardiography must be employed to avoid overlooking an unsuspected aortic arch abnormality.     

Cross-sectional echocardiographic assessment of atrioventricular septal defect: basic morphology and preoperative risk factors

Accurate evaluation of an atrioventricular septal defect is readily achieved by echocardiography. A sound understanding of the basic morphology and associated lesions is key to this approach. This article first details the features that are common to all hearts with an atrioventricular septal defect, irrespective of the presence or absence of an interatrial or interventricular communication. These common features are: (1) inlet outlet disproportion; (2) absence of the atrioventricular muscular septum; (3) abnormal position of the left ventricular papillary muscles; (4) abnormal configuration of the atrioventricular valves and, (5) cleft in the left atrioventricular valve. These are all predicated by a sprung atrioventricular junction. Second, is a detailed outline of the associated risk factors that must be identified by the echocardiographer prior to presenting the patient for surgical management, with the most important ones being abnormalities of the left atrioventricular valve and left ventricular outflow tract obstruction. Indeed, in this current era it is rarely necessary to perform other investigations prior to surgical repair.     

A Case of Transcatheter Closure of an Atrial Septal Defect Guided by Three Dimensional Echocardiography

Real time three dimensional transthoracic echocardiography (RT3DE) is rapidly emerging as the imaging modality of choice for assessment of atrial septal defects. This novel imaging modality provides incremental information about the morphology of atrial septal defects (ASD), allowing precise characterization of septal defects. Our case highlights the limitations of conventional echo imaging and the advantages of RT3DE in planning percutaneous ASD closure.     

Depicting of a Cleft Mitral Valve by Real Time Three‐Dimensional Transesophageal Echocardiography

We report the usefulness of real time three‐dimensional transesophageal echocardiography in comprehensive delineation of cleft mitral valve. This new technique may be a useful supplement to two‐dimensional and three‐dimensional transthoracic echocardiography in the assessment of this pathology. (Echocardiography 2010;27:356‐358)     

Incremental value of live/real time three‐dimensional transesophageal echocardiography in the assessment of ventricular septal rupture following acute myocardial infarction

Ventricular septal rupture is a serious complication following acute myocardial infarctions and is associated with a significant mortality rate. Classically, two‐dimensional transthoracic echocardiography has been used to diagnose this complication and visualize its location. Two‐dimensional transesophageal echocardiography has supplemented the transthoracic approach by providing more accurate assessment of the defect size and in guiding closure both percutaneously and intraoperatively. This modality, however, is limited to two‐dimensional views only, and a greater breadth of information is instead available through the use of three‐dimensional transesophageal echocardiography. We present a series of 11 patients in which live/real time three‐dimensional transesophageal echocardiography offered incremental benefits over two‐dimensional imaging alone.     

Transcatheter closure of multiple atrial septal defects. Initial results and value of two- and three-dimensional transoesophageal echocardiography.

AIMS: To examine the feasibility of transcatheter closure of multiple atrial septal defects using two Amplatzer devices simultaneously and to describe the importance and the role of two- and three-dimensional transoesophageal echocardiography in the selection and closure of such defects. METHODS: Twenty-two patients with more than one atrial septal defect underwent an attempt at transcatheter closure of their atrial septal defects at a mean+/-SD age of 30. 8+/-18.6 years (range 3.7-65.9 years) and mean weight of 56.6+/-25.5 kg (range 12.9-99 kg) using two Amplatzer devices implanted simultaneously via two separate delivery systems. During catheterization, two dimensional transoesophageal echocardiography was performed in all but one patient, during and after transcatheter closure, while three dimensional transoesophageal echocardiography was performed in six patients before and after transcatheter closure. RESULTS: Forty-four devices were deployed in all patients to close 45 defects (one patient with three defects closed by two devices). Two dimensional transoesophageal echocardiography was helpful in selection and in guiding correct deployment of the devices. The mean size of the larger defect, as measured by transoesophageal echocardiography was 12.8+/-5.9 mm and the mean size of the smaller defect was 6.6+/-3.0 mm. The mean size of the larger devices was 15+/-7.5 mm, and 8.4+/-3.7 mm for the smaller. Three dimensional transoesophageal echocardiography provided superior imaging and demonstrated the number, shape and the surrounding structures of the atrial septal defects in one single view. The median fluoroscopy time was 28.7 min. Device embolization with successful catheter retrieval occurred in one patient. Forty-four devices were evaluated by colour Doppler transoesophageal echocardiography immediately after the catheterization with a successful closure rate of 97.7%. On follow-up colour Doppler transthoracic echocardiography demonstrated successful closure in 97.5% at 3 months. CONCLUSIONS: The use of more than one Amplatzer septal occluder to close multiple atrial septal defects is safe and effective. The use of two- and three-dimensional transoesophageal echocardiography provided useful information for transcatheter closure of multiple atrial septal defects using two devices. Three-dimensional transoesophageal echocardiography enhanced our ability to image and understand the spatial relationship of the atrial septal defect anatomy.     

Complete atrioventricular canal repair with a decellularized porcine small intestinal submucosa patch

Background: Congenital heart defects affect nearly 1% of all children born per year in the United States, and complete atrioventricular canal (CAVC) accounts for 2%‐9%. While several patch materials have been used for septal defect closure during CAVC repair, clear superiority of one material over another has yet to be established.
Methods: A retrospective review of clinical outcomes following CAVC repair at Morgan Stanley Children’s Hospital/Columbia University was performed on opera‐ tions conducted from March 2010 to September 2017. Univariate and Kaplan‐Meir survival analyses were utilized to evaluate primary outcomes of interest following CAVC repair in the modern surgical era.
Results: A total of 73 patients were analyzed, with an average operative age of 22 weeks. The majority (71%) of the patients underwent a 2‐patch repair. A CorMatrix patch was used for ventricular septal defect(VSD) closure in 77% of the patients, and/or in 75% of atrial septal defect closures. There was one in‐hospital mortality (1.4%) due to respiratory failure. One patient required a pacemaker. At mid‐term fol‐ low‐up (1.6 years), a total of 7 patients required 8 reoperations due to cardiac‐related indications, including 5 for left atrioventricular valve (LAVV) repair, 1 for LAVV re‐ placement, and 2 isolated residual VSDs.
Conclusion: A standardized repair for CAVC results in excellent outcomes in the cur‐ rent era, with low rates of reoperations. CorMatrix for the closure of CAVC has proven to produce good results with equivalent outcomes to other patch materials. Its ease of use and pliability make it an attractive alternative for consideration.     

An interatrial tunnel: a rare form of atrial septal defects

Atrial septal defects (ASDs) account for approximately 6%–10% of congenital heart defects. The well‐known types of atrial septal communications are the ostium secundum, ostium primum, sinus venosus types, and coronary sinus defects. A 50‐year‐old female was referred for TEE for better assessment of MR severity and mechanism. 2D/3D‐TEE showed a rare combination of different abnormalities; bi‐leaflet mitral valve prolapse, cleft P2, cor triatriatum sinister, and a tunnel‐shaped IAS communication. To the best of our knowledge, this is a very rare case with a rare form of atrial septal defect that was not described before. We named this defect an interatrial tunnel.     

Assessment of atrioventricular septal defects by two dimensional echocardiography.

Ninety-six patients with an atrioventricular septal defect were assessed by two dimensional echocardiography. Forty-eight patients were judged as having two discrete valve orifices. In this group, 37 had an intact ventricular septum and 11 a ventricular septal defect. Two patterns of attachment of the valve leaflets to the interventricular septum were noted. Forty-eight patients had a common valve orifice. In 29 patients there was absence of tethering of the anterior bridging leaflet to the interventricular septum. A further 19 had varying degrees of tethering of the anterior bridging leaflet. A ventricular septal defect was identified under the anterior bridging leaflet in all cases. In 58 cases where the posterior bridging leaflet was identified, a ventricular septal defect was visualised in eight and missed in two. Seventy-eight patients had an ostium primum defect, 12 a common atrium, and a further six an intact interatrial septum. Two dimensional echocardiography provides in depth morphological information about the type of atrioventricular defect and can correctly identify the presence of a ventricular septal defect beneath the anterior or posterior bridging leaflet, unless it exists between short crowded chordae.     

Hypoplasia of the posterior mitral valve leaflet: Don’t forget to look beyond the mitral valve

Hypoplasia of the posterior mitral valve leaflet (PMVL) is a very rare finding in adulthood and can coexist with other congenital heart defects. In this image, a transesophageal echocardiography (TOE) carried out on a 59‐year‐old woman with a 2‐month history of dyspnea revealed a hypoplastic PMVL causing severe mitral regurgitation associated with a secundum‐type atrial septal defect (ASD) with left‐to‐right shunting. This case demonstrates how essential 3‐dimensional TOE is for a comprehensive assessment of the mitral valve and to improve the diagnostic accuracy of concomitant congenital heart abnormalities.     

Incremental Value of Three‐Dimensional Echocardiography over the Two‐Dimensional Technique in the Assessment of Combined Sinus of Valsalva Rupture into the Right Ventricle and Adjacent Perimembranous Ventricular Septal Defect

We describe the incremental value of live/real time three‐dimensional (3D) echocardiography over the 2D technique in the assessment of ruptured right sinus of Valsalva into the right ventricle associated with an adjacent perimembranous ventricular septal defect in an elderly patient.     

Routine leaflet augmentation of left atrioventricular valve in the repair of atrioventricular septal defect

Introduction

A better understanding of the morphology of complete atrioventricular septal defects (CAVSD) has impacted on surgical techniques and results. On some occasions the leaflet tissue is deficient and repair becomes difficult which leads to atrioventricular valve (AVV) regurgitation following the surgical repair of the AVSD.

Objectives

This study was conducted to evaluate a modified technique in which two patches where used to close the complete atrioventricular septal defect (CAVSD) with augmentation of the left atrioventricular valve (AVV) with the ventricular septal defect (VSD) patch.

Methods

The technique was performed on 105 infants with CAVSD at a mean age of 11.7 ± 23 months (median 5.7, range 1–135). Both superior and inferior bridging leaflets are divided routinely to expose the VSD. An autologous pericardial patch, sized precisely, is sutured to the ventricular septum. A 3–4 mm of extra patch is fashioned beyond the plane of the annulus and sutured to the divided leaflet of the left AVV. A second autologous pericardial atrial patch is attached to the body of the VSD patch at the plane of the annulus allowing 3–4 mm of the VSD patch to augment the left AV valve.

Results

There was one early death among these infants. At early postoperative echo all infants had no significant residual lesions. The contribution of the patch-augmented left AV valve to competency is clearly seen by two-dimensional echocardiography. At a mean follow up of 27 ± 10 months there were two late deaths with normal last echocardiography. There were only two children who progressed to severe left AV valve regurgitation needing reoperations.

Conclusions

This modified technique yields good anatomical repair. Allowing reconstruction of both AV valves independent of the other and is in particular helpful in cases of deficient left AVV tissue.