3D Echocardiography in Congenital Heart Disease Diagnosis and Transcatheter Treatment
Transesophageal echocardiography (TEE) is widely established in most centers as a mandatory imaging modality for guidance of percutaneous closure of septal defects: coupled with fluoroscopy, it provides detailed and reliable information in real time to the operator, enabling measurement of the defects and of their rims, visualization of devices during deployment, and release and evaluation of the results. Conventional two-dimensional TEE has however some intrinsic limitations. Obtaining detailed information such as number, size, shape, and spatial relationships of multiple, multifenestrated, or complex-shaped defects can often be challenging with two-dimensional imaging. Two-dimensional TEE guidance is also significantly limited in locating guidewires and catheters and assessing device position, particularly when multiple devices are used.
3DTEE video showing a secundum-type atrial septal defect from the left atrial aspect. The defect is located toward the septum secundum, close to the orifice of the superior vena cava. The floppiness of the thin-walled septum of the oval fossa is suggested by its “trembling” movement in the video (AVI 3046 kb)
As in Fig. 42.7, this 3DTEE video shows a case of secundum atrial septal defect associated to a very compliant patent foramen ovale. Both defects, seen from the right atrial side, are crossed by catheters (AVI 1570 kb)
As in Fig. 42.4, this 3DTEE video was obtained after placement of two occluding devices in two secundum-type atrial septal defects. The two devices are arranged at an angle, reflecting the normal curvature of the atrial septum (AVI 3684 kb)
3DTEE video showing, as in Fig. 42.10, a case of perimembranous ventricular septal defect, where the defect, oval in shape, is at some distance from the plane of the aortic valve. Accessory fibrous tissue from the tricuspid valve apparatus is also evident (AVI 4387 kb)
3DTEE video with color flow map of a case of paravalvular leak from a prosthetic mitral valve. The leak, clearly indicated by the jet of color, is crossed by a guide wire, which is seen oscillating with the cardiac cycle. This imaging technique proved to be very useful to locate the leak and to confirm its crossing by wires and catheters during the procedure (AVI 1914 kb)