Diagnosis of Congenital Heart Disease Using Two and Three Dimensional Echocardiography.pdf

1、This paper includes three parts as follows:PART ONE: EVALUATION OF ATRIAL SEPTAL DEFECT USING REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY:CAMPARISON WITH SURGICAL FINDINGS BACKGROUND:Morphological characteristics of atr

2、ial septal defect，including defect size and spatialrelationships between atrial septal defect and neighboring structures are of paramountimportance for the successful deployment of transcatheter septal occluder and surge

3、ry.OBJECTIVE:To evaluate the value of Three Dimensional Echocardigraphy (3DE)in the diagnosis ofatrial septal defect (ASD)and the measurement of its size by using the surgical findings as thecomparison standard.METHODS:T

4、wo-dimensional and real-time three dimensional echocardiography (RT3DE)were performedin 26 patients with atrial septal defect，and the echocardiographic data were compared with thesurgical findings.RESULTS:Significant cor

5、relation was found between defect diameter by RT3DE and that measuredduring surgery (r=0.77 p<0.001).The defect area changed significantly during cardiac cycle. Percentage change in defect sizeduring cardiac cycle ranged

6、 from 6%-70%.CONCLUSION:Our study shows that the size and morphology of atrial septal defect obtained with RT3DEcorrelate well with surgical findings. Therefore，RT3DE is feasible and accurate non invasiveimaging tool for

7、 assessment of atrial septal size and dynamic changes.PART TWO: EARLY FOLLOW UP OF COMPLICATION AFTER SURGICAL CLOSURE OF ATRIAL SEPTAL DEFECT BACKGROUND:Congenital defect of the atrial septum are common，they account fo

8、r 7-10% of all cardiacmalformations in childhood.Surgical repair of ASD began in 1948. In 1976 Mills and King reported successful closure ofan occlusion device inserted by a catheter passed into the atrium and later in 1

9、983 by Rashkind.OBJECTIVES:1. Follow-up of early complication and echocardiographic changes after surgical closure ofatrial septal defect.2. To evaluate Preoperative characteristics of the patients with ASD.METHOD:Betwee

10、n June 2007 to October 2008，there were sixty patients with ASD，among them thirtyone patients underwent surgical closure of atrial septal defect，out of 31 patients 24 patientswere post operative followed up. Their age ran

11、ged from 2yrs to 62 yrs.RESULTS:Preoperative characteristics of ASD patients were as follows: exercise intolerance 65%,recurrent respiratory infection 21%，cyanosis 6.6%，1st degree atrioventricular block 3.3%,preoperative

12、 pericardial effusion 3.3%.During Follow up period: No death was reported intraoperative，immediate postoperative andsix month post operative. Patients with respiratory complications were 25% and cardiacarrhythmia 4.1%.Af

13、ter surgical closure and six month of follow up period no clinical deterioration wasobserved.Echocardiographic changes:Pericardial effusion was 25.8%，Pre and Postoperative left atrial dimension in children were23.72±4.22

14、 and 25.81±4.44 respectively. In the adult group，Pre and Post operative were30.46±7.64 and 31.61±6.97 respectively. Significant slightly changes were observed for Si xmonth post operative left atrial diameter. However，th

15、ere were significant changes in rightatrial and ventricular dimension (p<0.001). Simultaneously，during this period 4.1% of thepatients have persistent right heart dilatation.CONCLUSION:Our study has continue to demonstra

16、te that surgical closure of atrial septal defect can be donewithout or with minimum morbidity and mortality rate，and no major complicationsoccurred during early follow-up in well specialized institutions with longtime ex

17、perienced likeour institution，however we had minor complications.We also advocates for early closure of secundum ASD to prevent functional changes orcomplication such as pulmonary hypertension which can prevent surgical

18、or devicemanagement of the patients lead to morbidity and mortality.PART THREE:REAL TIME THREE DIMENSIONAL ECHOCARDIOGRAPHIC ASSESSMENTS OF VENTRICULARSEPTAL DEFECTS: COMPARISON WITH SURGICAL MEASUREMENTS BACKGROUND:Vent

19、ricular septal defect are the most common congenital heart disease in children and adults.Diagnosis of these defects is by 2DE，but 3DE has been now shown to have several advantagesover 2DE particularly for visualization

20、of septal defect，morphology and rims of the defect,volume measurements and the whole valve evaluation.OBJECTIVE: To evaluate the size and morphology of ventricular septal defect usingtransthoracic three dimensional，and t

21、wo dimensional echocardiography with the surgicalfindings comparison.METHOD:Twenty three patients with ventricular septal defect age ranged from 2 years to 46 years wereexamined using real time three and two dimensional

22、echocardiography before surgery andcompared the size and morphology from surgical findings.RESULTS:The morphological data obtained from three dimensional images correlate with the surgicalfindings.The size measured from

23、three dimensional echocardiography correlate well with the surgicaldata r=0.847 and p<0.001. And measurements between 2DE and surgical findings were r=0.805；p<0.001.and the 3D largest diameter compared to 2 D maximum dim

24、ension r=0.577p<0.05. There were slightly significant dynamic changes during cardiac cycle 0.35%-26.50%.（mean15.88±7.75).CONCLUSION:The defect size and morphology of VSD measured by real time live three dimensionalechoca