Three-dimensional echocardiography in atrioventricular septal defects

BACKGROUND: Appropriate understanding of the real spatial features of the heart anatomy often requires the construction of mental 3D images in 2D echocardiography. Studies performed by 3D echocardiography that was developed in order to reduce this requirement are new. In this study, we aimed to compare 2D and 3D echocardiographic informations and surgical findings of those patients with AVSD. METHODS: The patients with AVSD who were diagnosed and followed by pediatric cardiology section and considered the need for surgery were admitted to this study, prospectively. By 2D echocardiography, performed with in a short time before the surgery, type of AVSD, maximal distance of ASD and VSD, AV valve leaflet count, localisation of AV valve regurgitation, Rastelli classification were determined. Then full-volume 3D echocardiogaphic datas were obtained. The 3D datasets were saved on the machine?s hard drive in DICOM format, and later transferred onto DVD for offline analysis. In different time the datasets were evaluated using Q-Lab program. At the surgery, surgical findings of the patients who underwent to total correction were collected. All these findings obtained by 2D, 3D echocardiography and surgery were compared statistically. RESULTS: Of the 27 patients (14 females, 13 males) the mean age was 40 ± 52.5 m (2-196), the mean weight was 12.67 ± 11.5 kg (4.25-56), the mean height was 82.24 ± 26,87 cm (55-170). Ten patients had partial AVSD, 17 patients had complete. According to physical examination, while 13 patients with Down?s syndrome, 14 patients were found to be normal. Nine patients were undergone to total corrective surgery. In all patients, the sizes and shapes of ASD, VSD and AV valve morphology were shown completely by 3D echocardiography. The defects were showing an ellipsoidal and irregular shape samples in 3D echo, and consisted of vertical and horizontal axes. The vertical axis was determined as the distance from the AV valve to the edge of the septum, whereas the horizontal axis was the distance between the top of septum and posterior margin of the defect lying along with the AV valves. There were positive correlation between 2D-3D and 3D-surgical measurements of these defect sizes (Spearman?s test). Correlations for the vertical size of primum ASDs, 2D/3D-Surgery were r: 0.781, p<0.05; r: 0.97, p<0,05 ; for the VSD?s (vertical) were found as r: 0.90, p<0.05; r: 0.957, p: 0.001. Although there were a good correlation among the vertical sizes, the horizontal axis that were identified by 3D echo and surgery were found to be statistically different (Wilcoxon?s test), compared to 2D (p: 0.012). The 3D echocardiography mean image acqusition time was 6,45 ± 3,06 (2,2-15) min, mean evaluation time, gradually decreased, was found 19,5 ± 17,3 (6-75) min. The 3D data count, acquisition and evaluation time were?nt affected by the heart rate. CONCLUSION: In the evaluation of AVSDs, to understand shape and size of the defects and morphology of the AV valve, 3D echocardiography was found better than 2D and well correlated with surgery. Data acqusition and evaluation time has came to acceptable limits during the learning period.