Real-time transthoracic three-dimensional echocardiography provides additional information of left-sided AV valve morphology after AVSD repair.

AIMS: The purpose of this study was to assess the feasibility of real-time 3D echocardiography (RT-3DE) data acquisition in adult patients after atrioventricular septal defect (AVSD) repair and to evaluate whether RT-3DE has additional value over 2D echocardiography, regarding morphology and function of the left-sided AV valve (LAVV). METHODS: Twenty consecutive patients with surgically corrected partial or complete AVSD were enrolled in this study. The 3DE data sets were acquired with the Hewlett-Packard Sonos 7500 echo system (Philips Medical Systems, Andover, MA, USA). Images were reviewed off-line with assistance of TomTec Echoview 5.2 software (TomTec Inc., Munich, Germany) by experienced observers. En face reconstructions, from, respectively, the ventricular and atrial view, were made to evaluate the LAVV morphology and motion. RESULTS: 3DE reconstruction of the LAVV was feasible in 17 of 20 patients (85%). Mean time of 3DE acquisition was 9+/-6 min. The quality of the 3DE images was optimal in 35%, good in 30%, sufficient in 20% and insufficient in 15%. Identification of the LAVV structures was importantly better facilitated from a ventricular view. Accurate identification of LAVV morphology was possible in all 17 patients (85%). Relationship of the LAVV and the abnormal position of the LVOT was easier to evaluate from the 3DE reconstructions than from 2D echo. CONCLUSION: This study demonstrate that RT-3DE is feasible in daily practice and provides new insight into the dynamic morphology of the left-sided AV valve and LVOT anatomy after AVSD repair.

Use of three-dimensional echocardiography for analysis of outflow obstruction in congenital heart disease.

To evaluate the feasibility and accuracy of 3-dimensional (3D) echocardiography in analysis of left and right ventricular outflow tract (LVOT and RVOT) obstruction, 3D echocardiography was performed in 28 patients (age 4 months to 36 years) with outflow tract pathology. Type of lesion and relation to valves were assessed. Length and degree of obstruction were measured. Three-D data sets were adequate for reconstruction in 25 of 28 patients; 47 reconstructions were made. In 13 patients with LVOT obstruction, 3D echocardiography was used to study subvalvular details in 8, valvular in 13, and supravalvular in 1. Four of these 13 patients had complex subaortic obstruction. In 12 patients with RVOT lesions, 3D echocardiography was used to study subvalvular details in 11, valvular in 12, and supravalvular in 2. Three-dimensional reconstructions were suitable for analysis in 100% of subvalvular LVOT, 77% valvular LVOT, 100% supravalvular LVOT, 100% subvalvular RVOT, 50% valvular RVOT, and 50% supravalvular RVOT. Twenty patients underwent operation, and surgical findings served as morphologic control for thirty-four 3D reconstructions (LVOT 17, RVOT 17). Operative findings revealed an accuracy at subvalvular LVOT of 100%, valvular LVOT 90%, supravalvular LVOT 100%, subvalvular RVOT 100%, valvular RVOT 100%, and supravalvular RVOT 100%. Quantitative measurements could adequately be performed. Three-D echocardiography is feasible and accurate for analyzing both outflow tracts of the heart. Particularly, generation of nonconventional horizontal cross sections allows a good definition of extension and severity of lesions.

Three-dimensional echocardiography enhances the assessment of ventricular septal defect.

By 3-dimensional echocardiography, the location, relation to the aortic and tricuspid valve, and the size of the ventricular septal defect was assessed and compared with 2-dimensional echocardiography and intraoperative findings. We concluded that 3-dimensional echocardiography accurately assesses the anatomy of the ventricular septal defect, provides additional information, and can be considered a valuable preoperative diagnostic tool.

Acute effect of maternal smoking on the maternal and fetal cardiovascular system.

Maternal and fetal cardiovascular dynamics were studied in relation to maternal smoking in 18 healthy nulliparous subjects randomly divided into a smoking (n = 9) and a control group (n = 9) between 34 and 38 weeks of gestation. At the end of the study, data from 7 smokers and 7 controls were available for analysis. A significant rise in maternal heart rate and systolic blood pressure was observed during and following smoking one cigarette. A significant increase in fetal heart rate occurred following smoking, whereas mean blood flow velocity and vessel diameter in the fetal descending aorta as measured by pulsed Doppler and time motion techniques did not demonstrate any significant changes.

M-mode ultrasonic assessment of fetal cardiovascular dynamics.

A combined two-dimensional real-time and M-mode technique for measuring fetal right and left ventricular cardiac geometry and function is presented. From 64 normal women studied between 27 and 41 weeks gestation, 53 technically acceptable recordings showed a significant increase in left and right ventricular size. Both ventricles are geometrically and functionally uniform. Mean velocity of blood flow in the fetal descending aorta as measured by pulsed Doppler ultrasound showed no relation to mean velocity of fractional shortening of both cardiac ventricles.

Normal cardiac ventricular geometry and function during the last trimester of pregnancy and early neonatal period.

Fetal and early neonatal left and right ventricular cardiac geometry and left ventricular cardiac function were studied by M-mode technique in a cross-sectional study between 28 and 40 weeks of gestation (n = 227) and a longitudinal study from 24 h before until 48 h after delivery (n = 15). Antenatally both ventricles were geometrically uniform; there was a 3.2-3.4-fold increase in left ventricular volume and a nearly 3-fold increase in left ventricular stroke volume and cardiac output. During the early neonatal period the right ventricular transverse diameter reduced in size; there was a further 1.1-fold rise in left ventricular volume and a further 1.2-1.3-fold rise in the left ventricular stroke volume and cardiac output.

Enhanced visualisation of the right ventricle by contrast echocardiography in congenital heart disease.

BACKGROUND: Contrast echocardiography improves endocardial border detection of the left ventricle. Whether this is also true for the right ventricle (RV) is unknown. The aim of this study is to assess whether the use of contrast (Sonovue) echocardiography has additional value in RV endocardial border visualisation (EBV), and whether it has impact on the echocardiographic judgement of RV function. METHODS: Twenty adult patients with congenital heart disease were imaged using second harmonic two-dimensional echocardiography with and without contrast. Two independent observers analysed EBV of 13 RV wall segments in each patient. EBV was graded for each wall segment from 0 to 3 ( 0 = not visible, 3 = optimal visible). RESULTS: EBV improved in all patients with contrast echocardiography compared to second harmonic imaging (mean EBV 1.00 +/- 0.77 with second harmonics, 2.13 +/- 0.75 with contrast, P < 0.0001). The benefit was most evident in the near-field images. In 55% of the patients visual estimation of RV function changed with contrast echocardiography. CONCLUSION: The use of contrast echocardiography is superior to second harmonic imaging for RV EBV. Improved EBV may allow more accurate assessment of RV dimensions and function.