Multiple Crystal Echocardiographic Evaluation of Endocardial Cushion Defect

A prototype multiple crystal echocardiographic system developed by Bom and associates was used to evaluate cross-sectional cardiac anatomy in real time in twenty infants and children with endocardial cushion defect (ECD). The findings were compared to fifty normal infants and children and nineteen patients with normal mitral valve anatomy but right ventricular enlargement (RVE). Three standard transducer positions for evaluation of sagittal and transverse cardiac cross-sections are outlined and the normal group and RVE subgroup described. Studies in patients with ECD demonstrated several distinctive abnormalities, consisting of multiple echoes in the mitral valve area, anterior mitral leaflet - septal apposition in diastole with reduced posterior motion in systole, and reduced excursion of the anterior mitral leaflet. In patients with complete atrioventricular (A-V) canal defects, the anterior leaflet was often observed passing across the plane of the ventricular septum into the right ventricle during diastole, and in some of these patients the anterior mitral leaflet was related to the tricuspid annulus. Multiple crystal cardiac ultrasonography allows a more precise determination of intra- and extracardiac spatial relationships and is easier to perform than single crystal echo. The new technique provides clinical information helpful in evaluating patients with possible ECD and gives some indication of the severity of the defect.