Volumetric analysis of the right ventricle in children with congenital heart defects: comparison of biplane angiography and transthoracic 3-dimensional echocardiography

Right ventricle three-dimensional echography in corrected tetralogy of fallot: accuracy and variability

AIMS

To evaluate right ventricular (RV) volume and ejection fraction (EF) in adult normal subjects and repaired tetralogy of Fallot (ToF) with 3D trans-thoracic echocardiography (3DE) and a semi-automatic border detection algorithm.

METHODS AND RESULTS

Fourteen healthy volunteers and 20 patients with repaired ToF (mean age 31 +/- 14) underwent 3DE and MRI within the same day. Right ventricular end-systolic volume (ESV) and end-diastolic volume (EDV) and EF were measured by two observers using 3DE and compared with MRI measurements. Intra- and interobserver variability of 3DE and agreement between both methods were evaluated using Bland-Altman analysis. Over or underestimation of 3DE in comparison to MRI was assessed using paired t-test. Intra- and interobserver variability of 3DE was excellent with intraclass coefficient of correlation (ICC) ranging from 0.85 to 0.99 and from 0.85 to 0.98, respectively. Three-dimensional echocardiography underestimated ESV and EDV (P < 0.001) but agreement between 3DE and MRI was excellent (ICC = 0.88 and 0.87, respectively). Ejection fraction was 47.7 +/- 7.8 with 3DE and 47.9 +/- 6.7 with MRI, agreement between both methods was good (ICC = 0.72).

CONCLUSION

Three-dimensional echocardiography combined to semi-automated quantification software shows fair agreement with MRI for RV volumes and EF measurement in patients with repaired ToF and adequate intra- and interobserver variability. These results suggest applicability for serial follow-up of patients with right heart congenital disease. However, the accuracy of 3DE echo diminishes with larger RV volumes, in part due to current difficulty to include the entire RV in the imaged sector. Technical progress in transducers beam geometry is likely to address this issue.

Echocardiographic and morphological evaluation of the right heart after closure of atrial septal defects

OBJECTIVE

To evaluate echocardiographically the function and morphology of the right heart subsequent to transcatheter closure of atrial septal defects.

METHODS

We performed echocardiographic studies in 73 patients undergoing transcatheter closure of atrial septal defects 1 day prior to closure, and then 3 days and 3 months after closure. We calculated the antero-posterior diameter of the right ventricle, the transverse diameter and length of the right atrium, the pulmonary arterial pressure, and the velocities of systolic movement and early and late diastolic movement of the basal parietal walls of the right ventricle.

RESULTS

The atrial septal defects varied in size between 8 and 33 millimetres, and were closed using occluders measuring from 10 to 40 millimetres. At 3 days after closure, the antero-posterior diameter of the right ventricle, the transverse diameter and length of the right atrium, the pulmonary arterial pressure, and the velocities of mural motion were all significantly decreased. After 3 months, the size of the right heart had more or less normalized.

CONCLUSIONS

Transcatheter closure of atrial septal defects produces marked improvement in the function and geometry of the chambers of the right heart, reducing pulmonary arterial pressure as well as abolishing the interatrial shunt.

Normal Values of Right Ventricular Size and Function by Real-time 3-Dimensional Echocardiography: Comparison with Cardiac Magnetic Resonance Imaging

BACKGROUND

Assessment of right ventricular function by 2-dimensional echocardiography (2DECHO) is difficult because of its complex shape. Real-time 3-dimensional echocardiography (RT3DECHO) may be superior.

METHODS

End-diastolic volume, end-systolic volume, stroke volume, and ejection fraction obtained by 2DECHO, RT3DECHO short-axis disk summation (DS), and RT3DECHO apical rotation were compared with cardiac magnetic resonance imaging in 71 healthy individuals.

RESULTS

RT3DECHO DS showed less volume underestimation compared with 2DECHO and RT3DECHO apical rotation. Test-retest variability for RT3DECHO DS end-diastolic volume, end-systolic volume, stroke volume, and ejection fraction were 3.3%, 8.7%, 10%, and 10.3%, respectively. Normal reference ranges of indexed volumes (mean +/- 2SD) for right ventricular end-diastolic volume, end-systolic volume, stroke volume, and ejection fraction were 38.6 to 92.2 mL/m(2), 7.8 to 50.6 mL/m(2), 22.5 to 42.9 mL/m(2), and 38.0% to 65.3%, respectively, for women and 47.0 to 100 mL/m(2), 23.0 to 52.6 mL/m(2), 14.2 to 48.4 mL/m(2), and 29.9% to 58.4%, respectively, for men.

CONCLUSIONS

RT3DECHO DS is superior to RT3DECHO apical rotation and 2DECHO for right ventricular quantification, and performs acceptably when compared with cardiac magnetic resonance imaging in healthy individuals.

Transesophageal 3-dimensional versus cross-sectional echocardiographic assessment of the volume of the right ventricle in children with atrial septal defects

The study was designed to investigate the value of assessing right ventricular volume by transoesophageal 3-dimensional echocardiographic techniques compared with the standard transoesophageal cross-sectional approach. Echocardiography was performed using a multiplane probe. The 3-dimensional data sets were reconstructed after electrocardiographic and respiratory gated scanning, calculating the 3-dimensional volumes by the method of multiple slices. Cross-sectional determination of volume was performed using a modified area-length method, and the biplane multiple slice method following Simpson's rule. We studied 15 patients, with ages ranging from 6 to 19 years, and body surface areas from 1.1 to 1.67 square metres. It proved possible top determine volumes with both methods in all patients. As determined by 3-dimensional echo, volumes were greater, being 113.0 plus or minus 61.2 millilitres at end-systole, and 61.7 plus or minus 36 millilitres at end-diastole, than those calculated from cross-sectional images using Simpson's rule, which gave values of 92.5 plus or minus 52 millilitres, and 41.3 plus or minus 22 millilitres. Compared to the values obtained using the area-length method, at 116.9 plus or minus 61 millilitres, and 60.3 plus or minus 30 millilitres, there were only small differences at end-systole, with a bias of 1.4, and limits of agreement of 20.9 millilitres, as well as at end-diastole, when bias was minus 3.8, and limits of agreement 22.3 millilitres. Correlation was also good, with coefficients of 0.93, and 0.91, respectively. The mean difference between the volumes by 3-dimensional acquisition and the multiple slice method was larger, with higher limits of agreement, at end-diastole showing bias of 20.5, and limits of agreement of 30.1 millilitres, and for end-systole bias of 20.4, and limits of agreement of 32.2 millilitres. Our data confirm that cross-sectional echocardiographic assessment of right ventricular volumes in children with atrial septal defects is quick, and reasonably reliable in clinical practice when employing the area-length method.

Feasibility and variability of three dimensional echocardiography in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Arrhythmogenic right ventricular dysplasia (ARVD/C) is a genetic cardiomyopathy characterized by fibrous fatty replacement of the right ventricular (RV) myocardium, leading to progressive RV failure and ventricular arrhythmias in young athletes. This study evaluated whether transthoracic, real-time, 3-dimensional echocardiography (3DE) can adequately assess RV morphology and function in ARVD/C by comparing 3DE with cardiac magnetic resonance (CMR), the current reference standard. Three-dimensional echocardiography was prospectively performed in 58 patients (23 with ARVD/C, 20 first-degree relatives with no ARVD/C, 8 with idiopathic ventricular tachycardia with no ARVD/C, and 7 healthy volunteers). All patients, except 15 patients with ARVD/C with implanted defibrillators, also underwent CMR. Three-dimensional echocardiography and CMR-derived RV volumes and ejection fractions were obtained by offline data analysis by blinded, independent observers. The mean age of the study group was 37 +/- 11 years (30 men). The feasibility of 3DE was high, and analyzable images were obtained in all subjects. Three-dimensional echocardiography revealed a wide variety of RV morphologic abnormalities in ARVD/C. There was a good correlation between 3DE and CMR for RV end-systolic volume (r = 0.72, p = 0.0001), RV end-diastolic volume (r = 0.50, p = 0.0001), and the RV ejection fraction (r = 0.88, p = 0.001). We found high intraobserver and moderate interobserver correlations for 3DE estimations of volumes and ejection fractions. In conclusion, 3DE measurements of RV volumes and ejection fractions closely correlate with CMR values and may be useful in the follow-up of patients with ARVD/C.

Problems with the right ventricular outflow tract: a review of morphologic features and current therapeutic options

Repair of complex malformations that necessitate restoration of continuity between the right ventricle and the pulmonary arteries can now safely be performed with low morbidity and mortality. Major concerns still remain on the long-term outlook for these patients, and about the durability of the different prostheses used to restore that continuity, whether during initial correction or at the time of reintervention for failure of the conduit or pulmonary regurgitation. In this review, we discuss the salient morphologic features of the right ventricular outflow tract, and then focus on the indications for early and late intervention, current therapeutic options, and outcomes.

Real-Time Three-Dimensional Echocardiography Using a Novel Matrix Array Transducer

Three-dimensional echocardiography has multiple advantages over two-dimensional echocardiography, such as accurate left ventricular quantification and improved spatial relationships. However, clinical use of three-dimensional echocardiography has been impeded by tedious and time-consuming methods for data acquisition and post-processing. A newly developed matrix array probe, which allows real-time three-dimensional imaging with instantaneous on-line volume-rendered reconstruction, direct manipulation of thresholding, and cut planes on the ultrasound unit may overcome the aforementioned limitations. This report will review current methods of three-dimensional data acquisition, emphasizing the real-time methods and clinical applications of the new matrix array probe.