Bengur, A.R.

Fleishman, C.E.

Kisslo, J.

Li, J.S.

Ohazama, C.

Ryan, T.

Sanders, S.P.

Stetten, G.

Elsevier - Publisher Connector 

Evaluation of ventricular outflow tract abnormalities using real-time three-dimensional echocardiography 

510A JACC Fcbnlury 19g,~ 
' rh ree-D lmene lona l  Echocerd lography  in 
Congenital Heart Dieenee 
Wednesday,  April 1, 1998, 3:00 p ,m, -5 :00  p ,m 
Georg ia  World Congress  Center, West Exhibit  Hall Level  
Presentat ion Hour: 3 :00 p .m, -4 :00  p,m, 
~ Quantitative and Qualitative 3.Dimensional 
Echocerdlogrephl© Evaluation of Aortic 
Cent©ration Using a Fast Fan.like Data 
Acquisition With en Intogratod 3,D System: In 
Vitro Validation 
F., Avelar, S,P Rain, P, Pslchotti, M, Kozakova, S, DoGnatro, T,.L, Hsu, 
Q,.L, CaD, 13, M~n~, N, Pandlan, TL#tp, Now England Medical Center, 
Boston, M~s, USA 
[laCkgrolgld; R0talional data acquisition has boon shown to provide 3D 
echo (3DE) Im~gos of a0rt~¢ abnormalities, in thl~ Mudy, we explored tire 
quantitative accuracy of 3DE, and the potential of a new inlografad 3DE 
lnstnlm0nl With rapid fan,like tin,On ~cqulstllon, (naodic conic!alien (Age) 
Method~: In 10 explicated pig hearts wllh inlacl aarlic fro0, AoC of v~l~/ing 
~ovodly was experimentally ~ro~fed Thes~ worn Imaged in a waler.b~llr 
using the prolotYpe (Eaaote) 3DE malrument that rapidly steered a 7 MH~ 
array ~t 1~5 degree intervals over a ~0 degree ar~ within 2 soc Usll~g 
a tam quantification ldgorllhm incolp0raled in Iho flail, we measured the 
area, porlmetm and diameters el the narrowed AoC segment. T',loso wore 
compared to analomic me~Buromonts h'om aortic specimens, 
R~,~ulf~: In all oxporlment~, we were ohio fe review the aortic imagos In 
3 dimensions instantly ~tler data collection and caution them in nny desired 
plan~, The pro.stenollc, alenoflc and post.slenobc aortic segments could be 
visualized cflsply. We could al~o obtain quantitative data immediately The 
correlation between anatomy nnd 3DE were: AoC area: y = 1 13x 06, 
0,g8, p .  00001; Perimeter: y =, t08x + 100, r =, 096, p , 00OOl: Max 
diameter: y ,. t Otx + 0,48, r =~ 092, p • 00001: M~n d~ametor: y = 083x * 
~,4g, r ,. 087, p - 0.001, 
C'enctlt.,¢ion: This mode at 3DE, when refined Into a transthorac~c o~ 
iron.esophageal tool, could be of vNuo in reliable quant~lation of the SOVOrlly 
ol aortic coarctalion and in pt~o~ling catheter-based interventions. 
• Impact of 3-Dimensions! Echocardlography in 
the Assessment of Atrial Septal Defect Device 
Occlusion 
Y Maono, L N Bon~on, C Boubn The Hospffal for Sick Chddren, Usa,empty 
of Tomato. Foronto, Ontario. Canada 
Background: To optimize the results of ASD device occh.|sron (CmdloSEAL 
Nitinot Medical Tocl~notogms), precise informahon about detocl number(s) 
size, location, and device position during implantation is cnticaL The pur- 
pose of this stu~ was to define the clinic~l ~pplcatton of 3D echo in the 
assessment and monitoring of patients undergoing ASD device oCclusion 
A,tetho~: Since 11/96, 36 cases (median age 8.6 yrs) wore evaluated by 
transesophageal erhocnrdiography (TEE) for potential ASD device occlusion 
as part of a hospital approved idol In all 36, 3D data wore acquired using 
a Hewlott-Packard software and muittplano TEE probe 3D images of ASD 
worn reconstructed using the TomToc system Fifteen cases have undergone 
device occlusion (awaiting imptnntatton: 6,not suitable: 15) 3D imagos wore 
mconstroctod after procedure in all 15, and during the procedure in 12 The 
Maximal ASD diameter was measured lrom 3D echo and compared with 
dimensions measured by 2D TEE and fluoroscopy balloon sizing. 
Results: 3D images demonstrated clear antedor ASD margin and the ex. 
tent of deficient anfonor rim in 33. The inferior-pc starter border of the ASD was 
clearly delineated in 20. Maximal ASD diameter uy 3D echo correlated with 
balloon ASD size (p = 0.02, r = 0.68). In 1 case with an elongated oval shaped 
defect, balloon sizing, by moditying the ASD morphology, clearly underesti- 
mated its dimension. Attar occlusion, position of all B arms were confirmed by 
3D imaging in 12/15 cases. Protruded arms and dynamic change in the size 
of residual defects were clearly visualized by 3D imaging. 3D echo during 
the procedure defined the mechanisms by which arm protrusion occurred. 
Conclusions: Current 3D reconstruction provides clinically relevant infor- 
mation in the selection and monitoring of patien*s undergoing ASD device 
occlusion, Information obtained by this t,~chniqt,a can improve "he under- 
standing of the mechanism of device deploymen~ and defect closure. 
1 - 21 I Throe-dimensional Transesophageal 
1 
23 1 1 
Echoeardlographl¢ Assessment of Left and 
Right Vantdcular Outflow "tract In Pediatric 
Congenital Heart Disease 
A, Dell'Agate, A H, Cromme.Diikhui~, F.J Mmiboom, JS  McGhio, 
M,A, Tnama, J,RTC, RoolandL AJ,JC, Bogers Emsmu~ Univolss~y 
Roltordam, The Netherlan#.~ 
Purpo,se; preoperative assessment with throe.dimensional transesophago_al 
echocnrdiogmphy (3D.TEE) el stoeosis (ST) nt sub.valvular and supra.va!vu. 
lar level of tile loft (LVOT) and right (RVOT) vontnculnr outflow tract 
Mpthods: 3D.TEE was pedormefl ust before B~ageo/in !0 children rages 
5~1~ yearn) with a minisfufi;eed pedi~tti~ tmnsesophsgos! multiplano probe, 
Data were acquired rising mtatlonnl scann!ng at 2 dogmas tntowal w,h ECG 
nnd resptmfow gating The ouglow tract was reconstructed in tongitudinsl and 
hori~onfal (above nnd below Ih0 a0dic or pu!monan/valves) CroSS.SeCtions 
wilh enyplnno nnd volt!me rendering d!sptay The extension of the lesion, 
the relationship with the valves and the nature of Ihe ST were assossed 3D 
dynamic roconshuctiens were v~didalod by surgical hndings 
Rosults~ 3D reconstructions wore adequate re 9/t0 pts; m 1 pt 3D recon~ 
~tfuction foiled, due te inadequate gmn setting Among LVOT lesions, we 
¢0uld do!ino 2 sub.aDdle discr0fo sad lihrotic ST, t sub.aDdle Circular morn. 
brand and 1 stlpTa.aoRic Ilhfol.ts ring Among the ~VOT Iostom ~ there were I 
flbrotiC discrete sub.pqlmonaly ST, ~ muscular and 2 libromuscular ST In 2 
pfs the extension el the obstructing tissue to the mttral valve could be clearly 
soon Ironr'l a horizontal cross-section as looking from the loll ventocle In 2 
pts 3D imagos gave additional information, identdytng m t a, double chambe~ 
fight ventricle and m Iho olbot one the close relation at the supra.aortic ring 
wLlh one aorltc cu.~p One supraputmon~nt ST was not dtsplaye<t, due to 
scared resolution The an~ttomy ot the 3D reconstructions was confirmed by 
surgoW 
Conclusrons: 3D-TEE allows adequate assessment of both outflow tracts 
Parttculady helpful nm hunzontal cross-sections tram above and below, whech 
allow a defmitlon of tire degree and extension of the lesion 
[ ~ 1  Dynamic Morphology of Secundum Atrial Septal 
" Defect Evaluated by 3-Dimensional 
Echocardlography 
Y Maono. L.N, Benson. C Boubn The Hospital tar Sick Children. University 
of Toronto, Toromo. Onfano. Car~'mda 
Background Dynamic ch.=nges in morphology el the secundum ASD =s 
an important component el its physiology and has ,mphcations tar venous 
treatment modalities The purpose ot this study was to evaluate, by three~ 
dimensional (3-Dr echocaldlography, the contract!an pattern at sem.mdum 
ASD's through the cardiac cycle, and potential determinants 
Methods In 25 patients with an isolated detect Imodlan age 86 yrs) 3D 
echo data wine acquired using the Hewlott-Packacd so~'~aro and multiplanc 
transosophageal probe 3-D Imagos. assessed tram the RA were recon- 
structed using the TomToc system In 7 patients the pmsooce at a thin atnal 
soptum or multiple detects precluded clear dohneation at the defect margins 
and were therefore excluded. In 18 cases. ASD area. long and shurt ax~s 
dimensions, and the distance at the deficient antenor rim were measured m 
end-atrial diastole and systole Oval shaped defects (n = 10) were classit,ed 
mid 2 groups aCcording to the angle between the defect long-axis and the 
aorta; either parallel (anglo. 46) or perpendicular (.45). 
Results: ASD area s~gntficantly changed throughout he cardiac cycle 
(mean 63.7°,0. p .  0.001), ranging from 31% to 86"0 The detect contracted 
symmetrically and independent ot the angle to the aorta. The s=ze at the oval 
shaped detects parallel to the aorta changed more than those perpendicular 
(p . 0.01) Circular shaped defects changed size variably. The presence of 
aneuwsmal deformation el the atrial septum did not influence the percentage 
at shortening In all cases (10) with a deficient anterior rim. the distance el 
absent rim was significantly reduced (p = 0.01) during atrial contrachon. 
Conclusions: Dynamic changes of Ihe secundum ASD appear influenced 
by its morphology and location. This information can be relevant m improwng 
our understanding of the pathophysiology of atrial shunting, and its potential 
impact on device occlusion 
I 1231-1 231 Evaluation of Ventricular Outf low Tract 
I , J  
Abnormalit ies Using Real-time 
Three-Ctmensional Echocardlography 
JS  Li, C E Fleishman, C Ohazama, G Stetten, A R Bengur, T Ryan. 
SP  Sanders, J Kisslo Duke University Medical Center, Durham, North 
Carolma. USA 
Background: On the hypothesis that "~al-time 3D (RT3D) echo can provide 
unique views of structural anatomy over standard 2D echo. we evaluated 25 
pts with known ventricular outflow tract anomalies. 
Melhods PIS (ago: 7 d-15 ym wllh wetghts 2 5-53 kgs) were scanned 
wlrhout sedatton horn lho pataslomal. aptcat. and sub-castal wmdows The 
Duko RT3D syslom uses a malnn phased array lransduc~- (2.5-5 1 MHz) IO 
scan a OS pymmtdal volume nt 22 wU8 with fin lmaga dlsptay 01 standard 
B scan saclafs and rnctmed scan planes that can be ononted lhroughoul 
space Up to 3 s of movmg volumotnc data was acqutred in real.trme nnd 
stored bf oft~ltne anstysts to dnplay any combmatlon cl planes of to peltann 
wlumo rendenng on a compuler wactcstalion. 
RetwIts RT3D demomtmted abnonnatiias 01 LV an&or RV outftow tn 
all 25 ~1s wcth lhe followmg aagrwdes. subagrifc r&mo~1ft. sort@ steno- 
siwamsta. pulmonce sfenosrstatresta. TQF. DORV. 0-TGA, C-TQA. and AP 
wmdavu. hxkned and tntemectmg scan ptanes enabted unique y~sual~zat~on 
ol 1) -1 septum m relation lo VSD m TOF and WAV. 2) en%face stew* 
01 the defec( m AP wmdow and m the Nofwoxl anatomosm m aoctt~ alreeca, 
3) great vessel relahonehipar al mutttple levels ln D-TGA and L-TGA, and 4) 
tvpe and degree cl obstructton m aoftfc and pulmonary stenoat414lre9x. 
coficlusra?? qT3D echo can tdonttty ventncutar oulttaw tract abnormal- 
ttes The abttrty to mcbne. scans and pedorm volume rendering pennits novel 
vtstqlaalion ot vanotis compk?m structural abnomxatctles of ventncular oul- 
Ilow 
&+z%ground The 3D!4D reconstructed images ot ~ntracard&+c strtiurcs m 
congent heart &eases coutd be obtamed by the ham8horanc approach 
m ped6a?nc age 
~?e!m The %l senat 20 nnages wete obfamed at every 2 degrees (gated 
by resplrahon and ECG) by lhe rotatmnat scannmg from eilhet subxyphoid 
or pamsternal appmach. usmg rolalronal deve!ce From these tmages. 3D 
‘mages were ceconsmicted by Tomtec Echescanafter setting me proper 
cut@anes Tl%e study sub(ects were 93 cases with various congemtal hearl 
diseases Theagerangedhom3daystollyearsotd TheBSArangedhom 
016P148n+ 
Resu& 0193 cases, 309 3Di4D reconstmckms aece attempted 3D!40 
tmiq% were abtatned from 78 cases out of 93 cases (8%) In cases anh 
Bsa beyond 10 &. 30!4D tmages co&d no1 be obtained because ot poor 
penetrahon Among the 309 reconsrmcted 3D/4D images. 123 ‘mages l30=.) 
were ovatuated as ckmca!ty usefu! to assess tntracanItac anomakes The 
round shaped ostfum pnmum defects wre shown In 8 oul 0111 cases (73% 
with arnoventncutar canal detect (AVCDJ [P the antenor aspect 
The fmdmg 01 um%%fge posmofl ot the aorta between nght and left arn- 
oventn~br onhces was cteany seen m the cases with AVCD In the cramat 
aspecl 01 atnovenlncutar vahres In a case w* telralogy of Fatlo!. ac6X 
overndmg was cleady seen tn the antenor aspecl ot the right ventncte 
ConcIusron: 3D/4D wllh good amage quattty could be obtalned by the 
transtnoraclc approach \n newborn and intant 
p-@ziJ Echocardlographlc Quantltatlon oi Flow 
Parameters 
Wednesday, April 1,1998.3:00 p.m.-5~30 p.m. 
Georgia Work-4 Congress Center. WQSI IExhibIt #all LQVQI 
Presantation Hour: 3:OC p.m.400 p.m. 
I 
Infroducnon The pfoncmal flow corrvergence methad (FC) 18 mea ohen 
emptoyed wnh an assumpllon thal a h+?m~rphenca\ ~echvekxily surtace e~tm% 
for mosl onhces 
llfethods We derived 3D dgtlal color Doppler data In an m vflro puleattle 
How model Dgtal vetoc!ty data (pnor IO color aeqtgnmeni) horn c~rcutar. rect- 
angular. and tnangutar shaped onftces all ol area 0 24 cm? were acqutreu 
at 8 Row fates (40-120 ml&c) with an ATC HOI-3000 utlrasound wem 
controttrng rotalion of a 7 4 MHZ mu&plane probe Our digttal3D mhod st- 
towed wtonty vector reconslfucltons such that vanoua Doppler ~so+ekxttlae 
could be chosen. and the resuttmg 3D FC surfaces defmed We measured 
Ihe lengtha ot the mqor and mmof arls 01 the FC aweloctty surtace IP. 
3D space ta examme eccentnctty and computed 30 s&ace area dtrectty by 
adding FC arc lengths 
Flesultp~ The recrangu& o&e prodwxd w eccenmcny mdexes 
(0 85 I 0 05. p c 0.001 versus nrcular and tnangular o&x8), wtrlta nrcutar 
and Inangular o&xs y&&cl stnntar values (0 68 f 0 07 and 0 63 + 0.06, p 
= NS) The 3D derived FC Row ra!es cocretated qurte well with the actual ftow 
rales (r T 0 82. 0 Et3 and 0 87 for circular. rectangular and Inangular onhces, 
respectnretyt 
CondusMn The digtat 30 Dopier method we developed allows posl 
acqum?mn choocce ot dtrectty measura>te 3D rso-velonty surlaces @Ming 
robust and accurate FC flou rate compulanons 
i 1232-l 38 ] Advantages of a Digital Color Doppkrr hbthod 
for Computing Flow in Highly Pulselile VesWs 
G Byrd. T %ota. S WannRun. A Young, S Mamn. D J Sahn Oregon 
Hlfh Sff Urnv Flomand. OR. USA 
Background The atm ol 1tIls study was to delermme the accuracy oI @nat 
color Doppler catcutalron (ACM) for oetermlnmg regfonat now.5 ln hlghty 
pulsalrte vessels and also compare 11 wnh me convenhonal Pulsed Wave 
(PW) Doppler flaw calculafton memad 
Merho& to a Ilembte. d!stenSbte p&atIte Pulmonary Anery (PA) ftou 
model. we measured the wulum=s tlow from dfgal color) Doppler Images unm 
a Toshba PowcrVtsnrn (ACM), at 0.45”. and 9oe axes across Ihe ellIptIcal 
cross of rhe ‘PA’. which vaned In shape as well as tn dtameter (50% venalIon) 
wllh Ihe catiac cycle 
ResVns. Over 45 flows with a range at volumes from 2E cc 10 63 cdbeat. 
The ACM memod proved to be subs~anllatty more ac%urate than H?e f’W 
melhod (Fig.) ACM computes changes ttow area and ftow for pmfttes au. 
tomafcally. also. 1% raptdify and ease of use allowed us to calculate and 
average Ihe itows on the dtfferenl cmssect(lonal vessel axes. 
&nclusron: In hlghty putsattte great anenes lhe ACM method should have 
dtstlnct advantages over the + bV method. 


file:///data/core-remote/dit/data/elsevier/pdf/4a6/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMDczNTEwOTc5ODgwNjAyNQ==.pdf

Evaluation of ventricular outflow tract abnormalities using real-time three-dimensional echocardiography

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Elsevier - Publisher Connector