The evaluation of ventricular septal defect with three dimensional echocardiography

The evaluation of VSD with 3-D echocardiography not only demonstrates a hole in the septum but also demonstrates the exact localization, morphology , diameter and relationship with other tissues (tricuspid valve and aortic valve). Because of the limited images of cardiac structures with 2-D echocardiography, it is difficult to evaluate the exact shape of VSD in space. With the evaluation of VSD with 3-D real time echocardiography VSD can be shown `?en face?? and with these images the specific characteristics of VSD from the right ventricule can be seen and different defects in different anatomies can be seen.AİM: To demonstrate the structure (localization, shape and relationship ) of VSD with 3-d real time echocardiography.METHODS: In this study patients who have VSD and aged between 1 month to 18 years of age were included. The first evaluation of VSD was done with 2-D echocardiography and the localization , number and largest width of VSDs? were measured. The right ventricular sight of VSD , shape, number , localization ( perimembraneous , muscular ,??doubly committed??) ,the relationship with other tissues (tricuspid and aortic valve) and dimensions ( regarding cardiac cycle ; long and short axis of VSD at systole and diastole were measured) were detected with 3-D real time echocardiography. With 2-D and 3-D echocardiography the findings were evaluated and what other findings can be found by 3-D real time echocardiography was investigated.FINDINGS: 37 patients were included in this study. 3-D real time echocardiography was performed to 36 patients (%97,29). One patient (12year old girl) with poor acoustic window (obesity and pubertal period) was excluded. Patients? mean age was 38,94±46,48 months (1-198 months) and 16 patients (%44,4) were under 1 years of age. In 3-D real time echocardiography , the mean heart rate was 122,24±22,32/min (78-150/min) .The mean acquisition for 3-D images was 4,09±1,49min (2,15-10min). The mean acquisition time for 3-D echocardiography didn?t correlate with heart rate and age ( Mann Whitney U test p:0,629 and p:0,50).The mean image processing time for 3-D real time echocardiography was 20,13±10,46min (7-60min). In the first patient it took 60 minutes and in the last patient it took 14 minutes. In 31 patient (%86,1) it took under 24 minutes. The mean evaluation time if first 5 patients were excluded ( learning time, 60,45,40,35,32 minutes) was 16,54±3,94 (7-24min) . With the progression of the study shortening of the evaluation was seen (Spearmans? correlation test, r:-0,7, p<0,001); but it was no under 12 minutes.In this study 14 patients of 36 (%38,8) VSD was a component of congenital heart disease and in 12 patients it was associated with other defects. One of the patient had dextrocardia and it is shown that 3-D echocardiography can evaluate dextrocardia.There was no difference between 2-D and3-D echocardiography about detecting VSD localization (perimembraneous, muscular, `?doubly committed??) . But the inlet and outlet extension of VSD?s was better measured by 3-D real time echocardiography.The end diastolic largest width with and 2-D and 3-D echocardiography was 9,9±4,35mm( mean:9mm, 4-20mm) and 16,3mm (mean:14,9mm, 6,4-48mm). Comparing these results; the difference was significant. (Mann-Whitney U test p<0,005). VSDs? end-systolic largest width was 13,38±7,32mm (4,8-41,4mm).In 3-D echocardiographic evaluation systolic and and diastolic defect area was measured to show the dynamic characteristics of VSD. In 3-D echocardiography end-systolic and end diastolic area measures were 0,18-6,521 (mean:1,07±1,39cm², median:0.67 cm²) and 0,29-9,78 (mean:1,70 ±2,03 cm² , median:1,04 cm²). According to the comparement of cardiac cycle the findings were significant ( Mann-Whitney U test , p:0,011).The relationship of perimembraneous VSDs? with tricuspid valve and aortic valve were evaluated.The mean distance from the tricuspid valve to the VSD was 7,30 ±6,40mm and the aortic valve to the VSD was 5,10 ±7,90mm.In 10 (%27,8) patients VSD was totally or partially hidden by tricuspid valve tissue and in 3 (%8,3) with ventricular septal aneurysm.Tricuspit valve leaflet and aneurysm tissue was cleaned digitally and the exact morphology of VSD could be seen.In 35 patient (97,33) VSD were in irregular geometric shape, only in 1 patient (12?th patient) the defect was round.Outlet located perimembraneous VSDs? 3-d shape was rectangle which was pressed down inside.CONCLUSİON: This study is the first three dimensional echocardiographic evaluation of congenital heart defects in children. In this study we showed that VSD?s could be analyzed quantitatively using 3-D echocardiography. With right ventricular sight images we can evaluate the VSD?s position , dimension and shape truly. In the diagnosis and treatment of VSD?s 3-D real time echocardiography is a valuable method. Because of image quality, short acquisition time and evaluation time its usage will increase day by day.Key Words: Ventricular septal defect, Three dimensional echocardiography