Atrial septal defect echocardiography modalities

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Atrial Septal Defect Microchapters

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Patient Information

Overview

Anatomy

Classification

Ostium Secundum Atrial Septal Defect
Ostium Primum Atrial Septal Defect
Sinus Venosus Atrial Septal Defect
Coronary Sinus
Patent Foramen Ovale
Common or Single Atrium

Pathophysiology

Epidemiology and Demographics

Risk Factors

Natural History and Prognosis

Complications

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Transesophageal Echocardiography
Transthoracic Echocardiography
Contrast Echocardiography
M-Mode
Doppler

Transcranial Doppler Ultrasound

Cardiac Catheterization

Exercise Testing

ACC/AHA Guidelines for Evaluation of Unoperated Patients

Treatment

Medical Therapy

Surgery

Indications for Surgical Repair
Surgical Closure
Minimally Invasive Repair


Robotic ASD Repair
Percutaneous Closure
Post-Surgical Follow Up

Special Scenarios

Pregnancy
Diving and Decompression Sickness
Paradoxical Emboli
Pulmonary Hypertension
Eisenmenger's Syndrome
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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]

For a full discussion on the usage of echocardiography for atrial septal defect diagnosis click here.

Overview

Echocardiography is the preferred diagnostic tool in the evaluation of an atrial septal defect. A range of techniques may be employed to definitively image and diagnose the nature of an atrial septal defect. These include modalities such as: M-mode, trans-thoracic, trans-esophageal, contrast, and Doppler.

Echocardiography

A range of echocardiography techniques can be used to visualize and diagnose a suspected atrial septal defect. Each technique offers additional imaging information to support an atrial septal defect diagnosis.

M-mode

  • Effective modality for imaging moderate to large ostium secundum atrial septal defects
  • Provides imaging of:
  • Right ventricular enlargement
  • Paradoxical motion involving the interventricular septum

Disadvantages

  • M-mode modality can appear indicative of right ventricular overload. It is not substantial enough alone to make a full diagnosis of a suspected atrial septal defect.

Trans-thoracic echocardiography (TTE)

Trans-esophageal echocardiography (TEE)

Contrast echocardiography

Doppler

  • Used to demonstrate left to right flow.
  • Effective modality for:
  • Confirmation of a suspected atrial septal defect
  • Estimation of the defect size
  • Determination of the universal direction of flow across the septum
  • Determination of the usage of percutaneous closure and surgical therapies
  • Determination of high velocity flow, useful in patients with restrictive defects, obstructed pulmonary venous return and/or left atrial hypertension

Disadvantages

  • May show false positive shunting as caval flow and incorrectly set gain may appear as left to right flow.
  • Coloring across the interatrial septum can distort the perception of the shunt flow
  • Not effective in determination of sinus venosus defects

ACC / AHA 2008 Guidelines - Evaluation of the Unoperated Patient - Atrial Septal Defect (DO NOT EDIT)[1]

Class I
"1. ASD should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of RV volume overload and any associated anomalies. (Level of Evidence: C) "

References

  1. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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