Author + information
- Marietta Charakida, MD, PhD,
- Shakeel Qureshi, MD and
- John M. Simpson, MD⁎ ()
- ↵⁎Address for correspondence:
Dr. John M. Simpson, Department of Congenital Heart Disease, Evelina Children's Hospital, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, United Kingdom
IN 1988 LOCK ET AL. (1) DESCRIBED THE FIRST TRANCATHETER VENTRICULAR SEPTAL DEFECT (VSD) closure and since then a number of different devices have been developed. Both muscular and perimembranous VSDs have been closed by transcatheter means in specialized interventional centers (2). Complications have been described including tricuspid valve damage, aortic regurgitation, and heart block. Careful planning and guidance during the intervention is necessary (2).
Three-dimensional (3D) echocardiography has the potential to assist in interventional closure of VSDs by rendering the depth of field and allowing visualization of the ventricular septum in any desired orientation. With respect to the size of the defect, 2-dimensional echocardiographic measurements are typically made in 2 orthogonal planes, often achieved by altering the rotational angle of the transesophageal echocardiography probe. The operator is not able to visualize the entirety of the VSD in a single plane to be able to ensure that the true maximum length and breadth of the defect have been measured (Fig. 1,online videos 1– 23). 3D echocardiography permits projection of an en face view of the VSD from which accurate sizing can be performed irrespective of the shape or location of the defect and independent of pre-defined angles of insonation. VSDs may often have unusual or irregular shapes and the 3D technique has the ability to display such morphology and assist in the selection of the appropriate occlusion device (Fig. 2,online videos 4– 56). Assessment of adjacent structures and “rims” of the VSD is a major strength of 3D echocardiography compared to 2D echocardiography, because all rims around the defect can be visualized in a single sonographic projection and viewed from either the left or right ventricle (Fig. 3,online videos 7, 8). The size of a given rim is not constant around the defect, which needs to be accounted for during device placement. In practice, the rim of the defect below the aortic valve and proximity to the tricuspid valve are crucial to avoid compromising the aortic valve function or causing damage to the tricuspid valve. Adequacy of the size of rims will depend on defect size and the type of device to be deployed. Finally, with the use of live 3D echocardiography, the precise orientation of the occlusion device guidance of catheters can be accurately monitored, and there is less need for multiple changes in the rotational angle of the transesophageal echocardiography probe compared to 2D techniques (Fig. 4,online video 9).
For supplementary videos, please see the online version of this article.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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