Three-dimensional echocardiography improves the understanding of left atrioventricular valve morphology and function in atrioventricular septal defects.

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Presentation transcript:

Three-dimensional echocardiography improves the understanding of left atrioventricular valve morphology and function in atrioventricular septal defects undergoing patch augmentation Catherine Barrea, MD, Stéphanie Levasseur, MD, Kevin Roman, MB, CHB, Masaki Nii, MD, John G. Coles, MD, William G. Williams, MD, Jeffrey F. Smallhorn, MBBS The Journal of Thoracic and Cardiovascular Surgery Volume 129, Issue 4, Pages 746-753 (April 2005) DOI: 10.1016/j.jtcvs.2004.07.023 Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, This montage is from patient 5 with a residual cleft, leaflet deficiency, and fusion of the superior bridging and mural leaflet commissure to the subvalvular apparatus. The upper left image is a surgical view of the inferior and mural commissure. The position of the aorta with respect to the superior mural leaflet has been superimposed on the surgical image. Note that the region of the cleft has been shifted to view the commissure. The top right image shows the fusion of the mural and superior leaflets to the subvalvular apparatus. The bottom right image is the surgical view of the residual cleft. The bottom left image is the 3D image of the LAVV as seen from above and oriented in a surgical view. Note the keyhole configuration of the orifice caused by the fusion of the superior and mural leaflets, which is indicated by the black arrow and corresponds to the black arrow in the upper right image. The residual cleft is indicated by the asterisk and corresponds to the surgical image in the lower right image. AO, Aorta; IBL, inferior bridging leaflet; ML, mural leaflet; SBL, superior bridging leaflet. B, This montage demonstrates the TEE findings in patient 5. The left panel shows the residual cleft seen in diastole, with the right panels demonstrating the systolic appearance of the valve. Note that in comparison with Figure 1, A, Figure 2, and Figure 3, specific detail is lacking in the 2D image. LA, Left atrium; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 746-753DOI: (10.1016/j.jtcvs.2004.07.023) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, This montage is from patient 3 and demonstrates the sites of regurgitation. Note the residual hole in the surgical image at the base of the repaired cleft in the lower left panel, as indicated by the black arrow. The position of the aorta has been superimposed on the surgical image. This corresponds to that seen by means of 3D echocardiography in the lower right panel, as imaged from above in a surgical view. The upper left image is the LAVV as seen from below during systole. Note the residual defect in the vicinity of the inferior and mural leaflets, as indicated by the white asterisk. The upper right panel represents the 2 regurgitant jets with the tissue stripped away. Note the smaller jet (black arrow) from the residual hole and the larger jet (white asterisk) from the posteroinferior region. AO, Aorta; IBL, inferior bridging leaflet; ML, mural leaflet; RVOT, right ventricular outflow tract; SBL, superior bridging leaflet. B, This panel of images is also from patient 3 and demonstrates the commissures of the LAVV as seen from a surgical and 3D perspective (diastolic view from below by means of echocardiography). Note the well-formed commissure between the superior and mural leaflets, both in the surgical image in the lower right panel and the 3D image in the upper right panel, which are seen between the 2 asterisks. The lower and upper left panels show the poorly formed inferior and mural commissure, which was the site of the major regurgitant jet. Also note the tiny residual cleft in the LAVV. The position of the aorta has been superimposed on the surgical view. AO, Aorta; IBL, inferior bridging leaflet; ML, mural leaflet; RVOT, right ventricular outflow tract; SBL, superior bridging leaflet. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 746-753DOI: (10.1016/j.jtcvs.2004.07.023) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 This panel is from patient 2 with the partial cleft between the superior and inferior bridging leaflets. The upper panel shows the left atrioventricular valve as seen from below during systole. Note that there is a residual deficiency in the center of the valve caused by poor coaptation of the leaflets. The lower panel demonstrates the 3D appearance of the valve after it was patched. Note the crescent-shaped template that was used to fashion the patch, which can be seen in the 3D image, as outlined by the asterisks. Note how the valve coapts well and that there was minimal residual regurgitation. AO, Aorta; ML, mural leaflet; IBL, inferior bridging leaflet; SBL, superior bridging leaflet; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2005 129, 746-753DOI: (10.1016/j.jtcvs.2004.07.023) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions