Two-Dimensional Versus Transthoracic Real-Time Three-Dimensional Echocardiography in the Evaluation of the Mechanisms and Sites of Atrioventricular Valve Regurgitation in a Congenital Heart Disease Population

Takahashi, Ken; Mackie, Andrew S.; Rebeyka, Ivan M.; Ross, David B.; Robertson, Murray; Dyck, John D.; Inage, Akio; Smallhorn, Jeffrey F.

doi:10.1016/j.echo.2010.04.017

« Previous Next »Journal of the American Society of Echocardiography
Volume 23, Issue 7 , Pages 726-734, July 2010

Two-Dimensional Versus Transthoracic Real-Time Three-Dimensional Echocardiography in the Evaluation of the Mechanisms and Sites of Atrioventricular Valve Regurgitation in a Congenital Heart Disease Population

Ken Takahashi, MD
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
Andrew S. Mackie, MD
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
Ivan M. Rebeyka, MD
- Department of Surgery, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
David B. Ross, MD
- Department of Surgery, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
Murray Robertson, MD
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
John D. Dyck, MD
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
Akio Inage, MD
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
Jeffrey F. Smallhorn, MBBS
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
- Reprint requests: Jeffrey F. Smallhorn, MBBS, University of Alberta Hospital, Room 4C2, Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2B7, Canada.

published online 04 June 2010.

Background

Data are lacking on the utility of real-time three-dimensional (3D) echocardiography (RT3DE) in congenital abnormalities of the atrioventricular (AV) valves. The purpose of this study was to determine whether transthoracic RT3DE is superior to combined transthoracic echocardiography and two-dimensional (2D) transesophageal echocardiography in determining mechanisms and sites of AV valve regurgitation in congenital heart disease.

Methods

Between January 2005 and November 2007, 48 consecutive patients were studied prior to AV valve repair (22 left AV valves and 26 tricuspid valves) using 2D transthoracic echocardiography, 2D transesophageal echocardiography, and transthoracic RT3DE. Ages ranged from 24 days to 30 years. The 2D data were reviewed by blinded observers, and the real-time 3D data by a separate observer. In all patients, surgical findings were documented by a surgical report, while in 40, video recordings were also available. Surgical findings were used as the reference standard for structural abnormalities; RT3DE was the reference standard for the site of AV valve regurgitation.

Results

Compared with 2D echocardiography, RT3DE provided superior detail of the mural leaflet and anterior commissural abnormalities for the left AV valve. For the tricuspid valve, improved detection of leaflet abnormalities, prolapse of the anterior and posterior leaflets, and commissural pathology was observed by RT3DE. Apart from a central location, surgical saline testing correlated poorly with jet location on RT3DE.