2D/3D in Evaluation of Atrial Septum Roberto M Lang, MD OSTIUM SECUNDUM ASD: 2D AND 3D TNSESOPHAGEAL ECHO 1
Biplane views 90 0 3D Acquisi on Acquire 3D volume Lang RM et al. JASE 2012;25:3 46. Right atrial view 3D Display Le atrial view Rotate to en face le atrial view Display with superior vena cava at 11 o clock posi on Display with right upper pulmonary vein at 1 o clock posi on Inter-atrial Septum Data Acquisition Ao PFO Ao A AS RPV SVC AS IVC S L view view A S R P 2
Patent foramen ovale (PFO) Johri A. Heart 2011;97:1441e1453 THE PATENT FOMEN OVALE (PFO) Ao PFO RPV A AS 3
Inter-atrial Septum 90 % IAS FO MV LV View Sugeng L, Lang RM; J Am Coll Cardiol 4
Patent Foramen Ovale view IAS PFO Right atrial perspective LV view Left atrial perspective Patent Foramen Ovale 5
SUBTYPES OF ATRIAL SEPTAL COMMUNICATIONS <1% 2-3% 80-90% 2-3% 2-3% J Am Soc Echocardiogr 2015;28:910-58 Ostium Secundum Ostium secundum ASD Johri A. Heart 2011;97:1441e1453 6
OSTIUM SECUNDUM ASD: TNSTHOCIC ECHOCARDIOGPHY Apical 4-chamber Parasternal SAX Subxyphoid X The IAS is parallel to the US beam in the apical 4- CH view and PSAX view The preferred view for imaging/measuring the IAS on TTE is the subcostal view. Here the IAS is perpendicular to the US beam TNSTHOCIC ECHOCARDIOGPHY FOR INTER-ATRIAL SEPTAL DEFECTS Agitated saline + maneuvers to increase pressures (Valsalva, cough) ASD Microbubbles appear in the < 3-6 heart beats Intra-pulmonary shunting Bubbles appear > 3-6 heart beats (confirmed if bubbles seen in pulmonary veins) 7
ASD CHACTERISTICS THAT SHOULD BE REPORTED ASD size and dynamic nature ASD shape Rims Presence of fenestrations Presence of an ASA ASD type ASD location ASD: Surgeons View SVC AO TV 8
OSTIUM SECUNDUM ASD: 3D TEE Oval Round Small Large S L Change in size over cardiac cycle 3D full volume right side view A RV Ao PA RV Ao PA Atrial diastole Atrial systole 9
COMPLEX ASD SHAPE: INACCUTE ASSESSMENT WITH 2D IMAGING X SVC AO SAX IVC TV 4CH 2D TEE MPR quantitation Y Z X 10
ASD s : TTE Apical 4-chamber 3D zoom: perspective OSTIUM SECUNDUM ASD: 3D TNSTHOCIC ECHOCARDIOGPHY 11
ASD CHACTERISTICS THAT SHOULD BE REPORTED ASD size and dynamic nature ASD shape Presence of fenestrations Presence of an ASA ASD type ASD location ME Bi-Caval: SVC rim TEE 4CH: Posterior rim TEE MESAX: Aortic rim TEE 4CH: AV rim ME Bi-Caval: IVC rim Sobrino A. Arch Cardiol Mex 2012;82(1):37-47 TEE LE: CS rim 12
Secundum ASD rims: 1.SVC 2. Aortic 3. AV 4. IVC 5.RPV 5 SVC 1 ASD 2 Ao LPV 2 1 ASD 5 RPV 5A 4 IVC 3 3 4 MV LV S L A en face view S R P en face view superior Secundum ASD Rim deficiencies SVC aortic Ao SVC RPA * SVC S Ao * CS R * A SVC inferior I IVC RPV RPV * * IVC 13
ASD CHACTERISTICS THAT SHOULD BE REPORTED ASD size and dynamic nature ASD shape Rims Presence of an ASA ASD type ASD location EHJCi 2011 14
COMPLEX ASD REPAIR COMPLETE ASSESSMENT OF THE INTER- ATRIAL SEPTUM IS IMPORTANT 1 2 1. Device deployed 2. Residual shunt 3. Fenestrations 3 15
COMPLETE ASSESSMENT OF THE INTER- ATRIAL SEPTUM IS IMPORTANT ASD CHACTERISTICS THAT SHOULD BE REPORTED ASD size and dynamic nature ASD shape Rims Presence of fenestrations ASD type ASD location 16
ATRIAL SEPTAL ANEURYSM Redundancy or saccular deformity of the atrial septum associated with increased mobility. Defined as an excursion of 10 mm from the plane of the atrial septum into the or or a combined excursion right and left of 15 mm ATRIAL SEPTAL ANEURYSM 17
ATRIAL SEPTAL ANEURYSM Amplatzer device closure ATRIAL SEPTAL ANEURYSM 1 day post device closure 18
RT3DE TEE GUIDANCE OF ASD CLOSURE A ASD B Guide wire C Delivery system Left atrial disc IAS IAS IAS D F Left atrial disc E I Left atrial disc F Left atrial disc IAS I Delivery system Right atrial disc Delivery system Right atrial disc PERI-INTERVENTIONAL 3D TEE PFO CLOSURE 19
ASD CHACTERISTICS THAT SHOULD BE REPORTED ASD size and dynamic nature ASD shape Rims Presence of fenestrations Presence of an ASA A T V D R V LVO T B E C R V LVOT Occluder Gerbode Defect 20
SINUS VENOSUS ASD Partial/complete absence of sinus venosus septum between SVC and the right upper pulmonary vein (SVC type) Right lower and middle pulmonary veins and the (IVC type) SINUS VENOSUS ASD An sinus venosus septal defect can be difficult to detect on TTE 21
SINUS VENOSUS ASD An sinus venosus defect can be identified on TEE by the absence of the atrial septum immediately beneath the orifice of the SVC SUPERIOR SINUS VENOSUS ASD MRI - Coronal 3D RUPV SVC MRI - Axial RV 22
TEE Color Doppler 3D TEE Right Atrium View 3D TEE Left Atrium View CS RV TV CS MV CS LV Cardiac CT Surgical Right Atrium View Surgical Left Atrium View AAO CS CS CS CARDIAC CT: UNROOFED CORONARY SINUS DEFECT Normal Abnormal Ao CS Ao CS Defect 23
UNROOFED CORONARY SINUS DEFECT: TNSTHOCIC ECHOCARDIOGPHY RV CS Defect Wall of the coronary sinus in the is deficient or absent UNROOFED CORONARY SINUS DEFECT: 2D TNS-ESOPHAGEAL ECHO 4-chamber view 100 0 CS Defect RV RV 24
3D TEE: THE UNROOFED CORONARY SINUS FROM LEFT TO RIGHT THE OPETING ROOM Defect CS 25