Atrial septal defect echocardiography
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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]
Overview
Echocardiography is the preferred diagnostic tool in the evaluation of an atrial septal defect. Out of the different types of echocardiographic modalities that can be used, transesophageal echocardiography can be used for all types of atrial septal defects. Trials have shown transesophageal echocardiography to be superior in diagnosing sinus venosus ASD compared to transthoracic echocardiography[1][2]. Other modalities like transthoracic echocardiography can be used for identification of the secundum type of atrial septal defects. During imaging the entire atrial septum from the orifice of the superior vena cava to the orifice of the inferior vena cava should be visualized. This helps in detecting sinus venosus defects and large ostium secundum defects that might extend up to that area. As an evaluative tool, echocardiograms can: locate the defects, identify the direction of shunting, identify associated anomalies, evaluate atrial and ventricular enlargement. In general, an atrial septal defect patient will present symptomatic evidence of hemodynamic disruptions between the left and right atrium.
Echocardiography
- Echocardiography is the preferred diagnostic imaging method for the evaluation of many congenital heart diseases, including atrial septal defect. An echocardiogram allows for identification of the functional issues with the heart's anatomy. In suspected atrial septal defect patients, an echocardiogram can locate the defect, identify the direction of shunting, associated anomalies, evaluate atrial and ventricular enlargement.
- Think about anomalous pulmonary veins, if echocardiography shows volume overload and no ASD is seen.
Advantages of Echocardiography
Echocardiography is one of the preferred modalities for diagnosing congenital heart defects including atrial septal defects. It provides with information that helps to do accurate diagnosis of the type of atrial septal defect along with any associated anomalies. Also, it helps in making therapeutics decisions about the condition.
Echocardiography can provide:
- Direct visualization of the defect in a subcostal 2-dimension view
- A visualization, when right ventricular volume overload is present of:
- Pulmonary arterial dilatation
- Right ventricular dilatation
- Anterior systolic/paradoxic septal motion
- Imaging of an associated anomalies
- Identify associated anomalies
- Evaluate atrial enlargement
- Evaluate ventricular enlargement
- Locate and size of defects
- Doppler flow echocardiography can identify:
- Shunt ratios
- Shunt volume
- Direction of shunt
- Pulmonary artery pressure
If the individual has adequate echocardiographic windows, it is possible to use the echocardiogram to measure the cardiac output of the left ventricle and the right ventricle independently. In this way, it is possible to estimate the shunt fraction using echocardiography.
Supportive Trial Data
In a study done on forty one patients with clinical diagnosis of atrial septal defect, transesophageal echocardiography was able to diagnose all the patients whereas transthoracic echocardiography was only able to diagnose 80% of them. Interestingly, 3 out of the 4 undiagnosed cases with trans-thoracic echocardiography were sinus venosus ASD. Transesophageal echocardiography is recommended when an atrial septal defect is clinically suspected but cannot be visualized by transthoracic echocardiography.[1]
Videos Showing Echocardiographic Findings in Specific Defects
Ostium Primum | Ostium Secundum |Patent Foramen Ovale | Sinus Venosus
2008 ACC / AHA Guidelines - Evaluation of the Unoperated Patient- Atrial Septal Defect (DO NOT EDIT)[3]
| 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
- ↑ 1.0 1.1 Kronzon I, Tunick PA, Freedberg RS, Trehan N, Rosenzweig BP, Schwinger ME (1991). "Transesophageal echocardiography is superior to transthoracic echocardiography in the diagnosis of sinus venosus atrial septal defect". J Am Coll Cardiol. 17 (2): 537–42. PMID 1991912.
- ↑ Mehta RH, Helmcke F, Nanda NC, Pinheiro L, Samdarshi TE, Shah VK (1991). "Uses and limitations of transthoracic echocardiography in the assessment of atrial septal defect in the adult". Am J Cardiol. 67 (4): 288–94. PMID 1990793.
- ↑ 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.