J Echocardiogr (2009) 7:39–40 DOI 10.1007/s12574-009-0006-4
IMAGES IN CARDIOVASCULAR ULTRASOUND
Large atrial septal defect visualized by real-time three-dimensional echocardiography Nobuhisa Watanabe Æ Manabu Taniguchi Æ Teiji Akagi Æ Takeshi Maruo Æ Yasuharu Tanabe Æ Shingo Kasahara Æ Kengo Kusano Æ Norio Koide Æ Shunji Sano
Received: 25 December 2008 / Revised: 10 March 2009 / Accepted: 10 March 2009 / Published online: 8 April 2009 Ó Japanese Society of Echocardiography 2009
A 29-year-old man was hospitalized because of dyspnea and palpitation. Electrocardiography demonstrated normal sinus rhythm and borderline right atrial enlargement. Twodimensional transthoracic echocardiography (2D-TTE) revealed a normal left ventricular systolic function. There was a paradoxical septal motion consistent with right ventricular volume overload (Fig. 1a). Although the right ventricle was mildly dilated, its systolic function was preserved. 2D-TTE revealed a large atrium without distinct interatrial septum (Fig. 1b). Left-to-right shunt flow was
N. Watanabe Y. Tanabe Division of Medical Support, Okayama University Hospital, Okayama, Japan M. Taniguchi (&) T. Akagi Division of Cardiac Care Unit, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama 700-8558, Japan e-mail:
[email protected] T. Maruo K. Kusano Division of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan S. Kasahara S. Sano Division of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan N. Koide Division of Laboratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
not detected clearly through the defect on color-flow Doppler imaging. Real-time three-dimensional echocardiography (RT3D-TTE) visualized a large defect of interatrial septum clearly (Fig. 2). The patient was referred for surgery. Only a tiny vestige of the interatrial septum could be confirmed with the naked eye, and the two atrioventricular valves were normal. The patch closure was performed successfully using a fresh autologous pericardial patch. Atrial septal defect (ASD) is a common congenital heart disease presenting in adulthood. Our patient showed a large secundum ASD like single atrium. It is sometimes difficult to distinguish a large secundum ASD from a single atrium. Levy et al. recommended that the term ‘‘single atrium’’ should be used to denote a condition comprising: (1) complete absence of the interatrial septum, (2) absence of malformation of the atrioventricular valves, and (3) absence of interventricular communication [1]. In our case, the morphological diagnosis was supposed to be a large secundum type atrial septal defect, because a small part of the interatrial septum was found. In this case, RT3D-TTE enhanced the understanding of the anatomy and spatial relationship between the defect and its adjacent structure. Previous study has shown the usefulness of RT3D-TTE for patient selection for surgical or transcatheter closure of atrial septal defects. It has been reported that RT3D-TTE allows accurate determination of the ASD location, ASD size, and surrounding tissue of the interatrial septum [2, 3]. Although our patient demonstrated a large part to be missing from the interatrial septum, RT3D-TTE could clearly visualize a large defect of the interatrial septum. RT3D-TTE provided additional, clinically relevant qualitative information for the evaluation of this patient with a large defect of the interatrial septum.
123
40
J Echocardiogr (2009) 7:39–40
Fig. 1 Two-dimensional echocardiography. a Parasternal twodimensional and M-mode echocardiogram showing a right ventricular enlargement and a paradoxical septal motion consistent with right
ventricular volume overload. b Apical four-chamber view showing a large atrial septum defect
Fig. 2 Three-dimensional echocardiography. a Three-dimensional echocardiographic parasternal four-chamber view: Both atria and the large atrial septal defect are visualized. The arrow indicates a tiny vestige of the interatrial septum. LA left atrium, RA right atrium, IVC
inferior vena cava. b The arrow indicates the large atrial septal defect, which can be visualized from an en face view. AV aortic valve, MV mitral valve, TV tricuspid valve
References 1. Levy MJ, Salomon J, Vidne BA. Correction of single and common atrium, with reference to simplified terminology. Chest. 1974;66:444–6. doi:10.1378/chest.66.4.444. 2. van den Bosch AE, Ten Harkel DJ, McGhie JS, Roos-Hesselink JW, Simoons ML, Bogers AJ, et al. Characterization of atrial
123
septal defect assessed by real-time 3-dimensional echocardiography. J Am Soc Echocardiogr. 2006;19:815–21. doi:10.1016/j.echo. 2006.01.016. 3. Kohyama K, Nakatani S, Kagisaki K, Kanzaki H, Masuda Y, Amaki M, et al. Usefulness of three-dimensional echocardiography for assessment of atrial septal defect: comparison to surgical findings. J Echocardiogr. 2007;5:79–83. doi:10.2303/jecho.5.79.
