Key result
3D transesophageal echocardiography measured significantly larger mean maximal diameters for oval atrial septal defects compared to 2D TEE (19.8±8.6 vs. 16.0±7.1; P<0.05).
Why the study?
2D TEE provides limited information for ASD assessment due to structural characteristics of the IAS, whereas 3D TEE offers an en face view for accurate defect and rim measurements before transcatheter closure.
Does 3D TEE provide different measurements of ASD dimensions and residual rims compared to 2D TEE/TTE in patients undergoing transcatheter closure?
Observational
Does 3D TEE provide different measurements of ASD dimensions and residual rims compared to 2D TEE/TTE in patients undergoing transcatheter closure?
Absolute Event Rate: 19.8% vs 16%
p-value: p=<0.05
3D TEE provides significantly different and potentially more accurate measurements of ASD dimensions and residual rims compared to 2D TEE, particularly for oval and complex-shaped defects.
3D TEE may refine ASD sizing and rim assessment over 2D TEE in complex cases; extends prior observations but leaves practice change open pending prospective validation.
Background: The assessment of interatrial septum (IAS) requires a standardized, systematic approach, including two-dimensional transthoracic echocardiography (2D TTE), 2D transesophageal echocardiography (2D TEE), and three-dimensional (3D) TEE. Although 2D TEE has been widely used for the preoperative assessment of atrial septal defect (ASD), its ability to provide reliable information is often limited due to the structural characteristics of IAS. The introduction of 3D TEE provides a unique “en face” view of IAS, which allows the visualization and accurate measurements of diameters, area, and rims of ASD. Hence, appropriate ASD imaging information is particularly important in successful transcatheter closure. Methods: In this retrospective study, 2D TTE/TEE, and 3D TEE were performed before ASD closure, with 2D minimal and maximal diameters, areas, and residual rims being recorded. Adequate 3D TEE imaging data sets were collected and then analyzed. ASD related parameters were compared using different echocardiography. Patients who underwent ASD closure completed a clinical follow-up. Results: The mean defect maximal diameter and aperture area by 3D TEE was significantly larger than that of the corresponding 2D TEE (P<0.05). There was no statistical difference in the minimal and maximal diameter or area by TEE for circular-shaped ASDs. For oval ASDs, mean minimal diameter on 2D TEE was larger than that on 3D TEE. The mean maximal diameter measured using 2D TEE was smaller than the 3D TEE measurement (16.0±7.1 vs. 19.8±8.6; P<0.05). For complex-shaped defects, there were statistical differences in minimal and maximal diameter between TEEs. Furthermore, 2D and 3D TEE had a longer superior vena cava (SVC) residual rim than did 2D TTE (P<0.05). The 3D TEE residual rims of the inferior vena cava (IVC) was significantly larger than the corresponding 2D TEE. There was a very strong correlation between the residual rim measurements using 3D and 2D TEE. However, the limits of agreement between 2D and real-time 3D TEE measurements were more apparent in the IVC rim group than in the other groups. Conclusions: Our study confirms the value of 3D TEE in assessing ASD shape and size reported by previous studies, and is also the first to accurately and systematically characterize ASD residual rim in complex ASDs.
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Deng et al. (2021) conducted an observational in Atrial septal defect. 3D transesophageal echocardiography vs. 2D transesophageal echocardiography was evaluated on Mean maximal diameter for oval atrial septal defects (p=<0.05). 3D transesophageal echocardiography measured significantly larger mean maximal diameters for oval atrial septal defects compared to 2D TEE (19.8±8.6 vs. 16.0±7.1; P<0.05).
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