The Clinical Value Of Real-time Three-dimensional Echocardiography In Common Congenital Heart Diseases

Objective: To observe and compare ultrasonic images of real-timethree-dimensional echocardiography (RT-3DE) and two-dimensionalechocardiography (2DE) in ventricular septal defect (VSD), atrial septal defect(ASD) and patent arterial duct (PDA). To explore the clinical value of RT-3DE indiagnose of ASD, VSD and PDA.Methods: Twenty normal subjects(10 male, 10 female, mean aged 18.9years)and totally 87 patients with congenital heart diseases (CHD)(45 male, 42female, mean aged 18.1 years), who were scheduled to undergo surgicaltreatment, including 24 patients with ASD, 43 patients with VSD and 20 patientswith PDA. Scannings in these patients and normal subjects were performed withthe Philips SONOS 7500 system equipped with matrix probe. Both 2DE andRT-3DE scannings were used in this study to evaluate the feasibility fordiagnosis and analysis of the lesions in the patients. Comparison of clinicalusefulness was also made with 2DE. Two modes of images were analyzed andcompared by two investigators who had also trained with RT-3DE,independently.The observed items included the site, type, shape, peripheral structures of lesions,as well as the information contained and pellucidity of the whole image. TheRT-3DE images were also compared with the findings of the operation.Results:(1) In total of the 20 normal subjects, the whole view of interatrialand interventricular wall in scaned area were displayed by RT-3DE.(2)RT-3DEcould allow more distinct visualization of the site, type, shape and peripheralstructures of ASD,VSD. The shape of the PDA could be demonstrated well,especially the cross section and shape of connection of the PDA with aorta andpulmonary artery. (3) Two observers agreed that RT-3DE provided morediagnostic information in 95.8%(23/24)of ASD,93.0%(40/43)of VSD,100%(20/20)of PDA,respectively,whereas 94.3%(82/87) overall. The shapecould be observed clearly in 23 of 24 ASD cases and 40 of 43 VSD by RT-3DE,whereas none by 2DE(P<0.001). The cross section and the shape of connectionof the PDA with aorta and pulmonary artery could be observed clearly in 19 of20 PDA cases by RT-3DE, whereas none by 2DE(P<0.001). (4) The Kappa valueof judgment by two observers was 1.000 in ASD, 0.788 in VSD, 1.00 in PDA,0.883 in all, respectively (P<0.001), and the Spearman correlation value was1.000,0.806,1.000,0.889. (5) The RT-3DE images of site in 95.8%(23/24)ofASD,100%(43/43)of VSD, shape in 95.8%(23/24)of ASD,93.0%(40/43)of VSD,100%(20/20)of PDA consistented with the findings of the operation.(6) RT-3DE could influence the diagnosis by 2DE in some cases.Conclusions: The stereoscopic views of the structures and lesions of heartcan be displayed in real time by RT-3DE. Compared with 2DE, RT-3DE canprovide additional spatial information of the site, shape, adjacent structure of thedefect. it can also provid more information about the shape of PDA. Theseresults demonstrate that RT-3DE is helpful in providing more detailednoninvasive diagnosis and preoperative planning.