Transesophageal Three-Dimensional Echo Assessment of Sinus Venosus Atrial Septal Defect

The incremental value of three-dimensional echocardiography over transesophageal multiplane two-dimensional imaging in the assessment of sinus venosus atrial septal defect is demonstrated in the present study.     

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)     

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.     

Transesophageal Echocardiographic Detection of Sinus of Valsalva Dissection

We describe a left sinus of Valsalva dissection diagnosed by transesophageal echocardiography and confirmed at surgery. A dissection of the left sinus of Valsalva has not been previously reported.     

Transesophageal Echocardiographic Identification of Atrial Septal Aneurysm

This case illustrates the usefulness of biplane transesophageal echocardiography in the diagnosis of an atrial septal aneurysm, which in some views, mimicked a mass lesion in the left atrium. (ECHOCARDIOGRAPHY, Volume 8, July 1991)     

Multiplane Transesophageal Echocardiographic Detection and Differential Diagnosis of Isolated Right Pulmonary Artery Agenesis

We present a case report of isolated right pulmonary artery agenesis detected by multiplane trans-esophageal echocardiography (TEE). A special emphasis is placed on its important role in the differential diagnosis and hemodynamic and functional evaluation of patients with unilateral pulmonary oligemia on chest radiograph. We also present a case report of pulmonary embolism with complete obstruction of the right pulmonary artery for better understanding and for comparison of TEE images in patients with pulmonary artery agenesis.     

Large Esophageal Hematoma Following Transesophageal Echocardiography‐Guided Device Closure of Atrial Septal Defect

A 47‐year‐old woman with a large ostium secundum atrial septal defect (ASD) and severe pulmonary artery hypertension underwent device closure of ASD under transesophageal echocardiography guidance. She developed a massive esophageal hematoma which was diagnosed 4 days after the procedure. The use of dual antiplatelets after the device closure further aggravated the hematoma. As the patient remained stable and the site of leak could not be identified by contrast studies, she was managed conservatively with nil per mouth, broad‐spectrum antibiotics, and continuous nasogastric aspiration. We were faced with the risk of thromboembolism after stopping antiplatelets versus the risk of increasing peri‐esophageal hematoma if they were continued. With careful monitoring for thrombus formation on the device, the antiplatelets were stopped and the hematoma resolved. The hematoma resolved by 10 days, and the antiplatelets were restarted gradually. Iatrogenic esophageal injury is an important cause of esophageal perforation, which is a condition with high mortality and morbidity. Esophageal perforation following device closure of ASD is particularly challenging as the scenario is worsened by the use of antiplatelets and they have to be discontinued with the attendant risk of thromboembolism.     

Incidence and Predictors of Atrial Septal Defect after Percutaneous Transvenous Mitral Commissurotomy – A Transesophageal Echocardiographic Study of 209 Cases

Background: The incidence of atrial septal defect (ASD) after percutaneous transvenous mitral commissurotomy (PTMC) ranges from 15.2% to 92% in small studies. Aim: To estimate the incidence of atrial septal defect (ASD) following PTMC and to determine the factors contributing to its development. Methods: We studied 209 patients with mitral stenosis (MS) undergoing PTMC. Transesophageal echocardiography (TEE) with color Doppler examination was performed to detect ASD. Results: TEE demonstrated ASD in 139 (66.5%) of 209 patients. The mean diameter of the interatrial septal defect detected by TEE was 4.47 ± 1.7 mm. The most common site of septal puncture was the inferior vena caval side of the interatrial septum followed by fossa ovalis. Color flow imaging across the defect showed left to right shunting in all the patients (100%). We examined the relationship of age, Wilkins score, left atrial volumes, the mitral valve orifice area, mitral valve gradient, and the degree of mitral and tricuspid regurgitation between the group that developed ASD and the group without ASD and found that none of these factors predicted the development of ASD. A residual ASD was seen in 11 patients (8.7%) at 6‐month follow‐up. Conclusion: Incidence of residual atrial septal defect immediately following PTMC by TEE color flow Doppler imaging is 66.5%. Surrogate markers of elevated left atrial pressures do not determine the development of atrial septal defect after PTMC. The majority of the defects close spontaneously and a residual defect is observed in 8.7% patients at 6 months.     

常用超声介导房间隔缺损封堵方法的优缺点比较

房间隔缺损是一种常见的先天性心脏病,经皮房间隔缺损封堵术是全世界首选的微创外科修补治疗方法.超声介导是经皮房间隔缺损封堵术中最重要的技术环节.目前,经食道超声心动图是最常用的超声介导方法,另外,经胸超声心动图以及心腔内超声也在运用.现试从经胸超声心动图、经食道超声心动图及心腔内超声的影像学特点、检查安全性,及并发症、检查费用等方面对上述三种方法进行比较.     

Partial Anomalous Pulmonary Venous Connection and the Nature of Associated Sinus Venosus Defect

Background: Partial anomalous pulmonary venous connection (PAPVC) is frequently associated with atrial septal defect (ASD), especially sinus venosus defect (SVD). Although Waggstaffe described the pathology of SVDs in 1868, the exact anatomic features and the nature of SVD remains controversial. SVDs with no posterior atrial rim were observed in recent years. However, no studies suggested that absence of the residual posterior atrial septal tissue might be the key feature of SVD. The aims of this study were to investigate if absence of posterior rim of atrial septum played a crucial role in patients with SVD. Methods: From January 2011 to December 2019, 256 children with PAPVC combined ASD and 878 children with isolated ASD who underwent corrective cardiac surgery were consecutively enrolled. Comprehensive review of preoperative transthoracic echocardiography, computed-tomography images and surgical findings were performed by experienced pediatric cardiologists. The subtypes of PAPVC, locations and types of ASD, and presence of posterior atrial rim of associated ASD were investigated. Results: PAPVC was right-sided in 244 children, left-sided in 6 children, and bilateral in 6 children. In PAPVC cases, ASD without posterior atrial rim existed in 226 SVD cases. ASD without posterior atrial septum only existed in cases with one or more right pulmonary veins returning to right atrium (RA) or to RA-superior vena cava junction. In cases with isolated ASD, there were 3 SVD, and the other 875 cases were secundum ASD. Conclusions: ASD without posterior atrial rims was associated with one or more right pulmonary veins returning to RA or RA-superior venous cava (SVC) junction. For SVD, the key feature is that the defect is in the posterior of the interatrial septum with no posterior septal rim, rather than adjacent to the SVC or to the inferior vena cava.     

Left Ventricular to Right Atrial Septal Defect Secondary to Blunt Thoracic Trauma Diagnosed by Transesophageal Echocardiography

A case report is presented of a 58-year-old man who developed a new holosystolic murmur 4 months after a high-speed motor vehicle accident. Cardiac catheterization demonstrated a left-to-right shunt at the right atrial level. Intraoperative transesophageal echocardiography (TEE) identified and localized a discrete atrioventricular septal defect associated with a shunt from the left ventricle to the right atrium without tricuspid regurgitation, findings that were confirmed after surgical exploration. TEE is recommended for patients with a heart murmur and a history of blunt cardiac trauma, may permit early diagnosis, and may allow surgical repair in selected patients without pre-operative catheterization. (ECHOCARDIOGRAPHY, Volume 8, May 1991)     

An Atrial Septal Ridge Diagnosed by Transesophageal Echocardiography

A left atrial ridge is an anomaly of irregular fusion between the septum primum and septum secundum.1 Aberrant fusion of the septa results in thickened and fibrotic tissue along the region of the fossa ovalis that will occasionally protrude into the left atrium.2 The presence of a left atrial ridge has multiple clinical implications due to its close proximity to the fossa ovalis. The location of this uncommon incongruence may make transseptal catheter-based approaches more challenging, underscoring the importance of imaging guidance to determine the ideal transseptal puncture site.Figure 1 shows cardiac images of a 64-year-old female with a history of severe mitral regurgitation, atrial fibrillation, sick sinus syndrome status post pacemaker implantation, pulmonary hypertension, systemic lupus erythematosus, and chronic kidney disease. She was seen by the valve team and underwent a transesophageal echocardiogram (TEE) to determine candidacy for transcatheter edge-to-edge repair of the mitral valve. Two-dimensional biplane imaging of the interatrial septum (IAS) shows a linear structure on the left atrial side of the fossa ovalis. Three-dimensional imaging of the IAS revealed that the structure was consistent with an atrial septal ridge.Open in a separate windowFigure 1(A) Transesophageal echocardiogram (TEE) 2-dimensional (2D) imaging of the interatrial septum with the atrial septal ridge shown by the yellow arrows. (B) 3D TEE rotated view of the interatrial septum with the fossa ovalis shown in plane with the ridge (yellow arrow). (C) Cardiac magnetic resonance cine SSFP 4-chamber image demonstrating the atrial septal ridge (yellow arrow). (D) The MitraClip transcatheter mitral valve delivery system safely traversed across the interatrial septum (red arrow) with the yellow arrow pointing towards the atrial septal ridge. RA: right atrium; LA: left atrium; AV: aortic valve; IAS: interatrial septum; FO: fossa ovalis; MV: mitral valve     

Echocardiographic Detection of Atrial Septal Defects: The Forgotten View

The right parasternal view is conventionally used to assess the aortic valve and the ascending aorta. We describe two cases in which the right parasternal view was helpful in assessment of the interatrial septum and the detection of atrial septal defects (ASD), including one case in which this view confirmed the presence of a defect not seen in any other echocardiographic view. Use of the right parasternal view should be considered for assessment of the interatrial septum, particularly when there is a high index of suspicion for an atrial septal defect but no defect is seen on conventional views. It should also be used to exclude the possibility of multiple defects even when an ASD is visualized using conventional imaging planes. (Echocardiography 2010;27:97-99)     

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.