Key result
Real-time 3D echo detects ~27% more iASDs post-PTMC than standard 2D echo.
Why the study?
Does real-time 3D echocardiography improve the detection and quantification of iatrogenic atrial septal defects compared to 2D echocardiography in patients undergoing percutaneous transvenous mitral commissurotomy?
Observational (n=110)
No
Does real-time 3D echocardiography improve the detection and quantification of iatrogenic atrial septal defects compared to 2D echocardiography in patients undergoing percutaneous transvenous mitral commissurotomy?
Absolute Event Rate: 85.5% vs 67.3%
p-value: p=<0.0001
RT3DE is more accurate and reliable than traditional 2DE for detecting and quantifying iatrogenic atrial septal defects after percutaneous transvenous mitral commissurotomy.
RT3DE may enhance iASD detection after PTMC; leaves open whether it improves outcomes or warrants routine adoption.
INTRODUCTION: Percutaneous transvenous mitral commissurotomy (PTMC) is a safe and effective procedure for relief of severe mitral stenosis. PTMC is being done widely and many transseptal procedures requiring large diameter catheters, sheaths are becoming popular. The knowledge of iatrogenic atrial septal defect (iASD) is vital. This study assessed the use of real-time 3D echocardiography (RT3DE) and incidence of iASD in a cohort of patients undergoing transseptal catheterization during PTMC. METHODS: One hundred ten patients underwent PTMC. The reliability and accuracy of RT3DE for iASD detection was determined, RT3DE was compared with 2D echocardiography (2DE) for iASD occurrence, influencing variables analyzed and followed up for 1 year. RESULTS: RT3DE is more reliable and accurate for the study of iASD than 2DE. Color RT3DE detected iASD in 94 (85.5%), with 2DE iASD was detected in 74 (67.3%) (P < .0001).On follow up 85% had iASD post procedure, 56% at 6 months, 19% at 1 year follow up. The mean iASD diameter was 5.41 ± 3.12 mm and area 6.57 ± 3.81 mm(2). iASD correlated with patient height, Wilkins score, pre-PTMC LA 'v', and post-PTMC LVEDP. CONCLUSION: RT3DE imaging is superior in accuracy to traditional 2DE techniques. All the modes of RT3DE are useful in the assessment of iASD. iASD measured by RT3DE correlates with several patient, procedural and echocardiographic variables.
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Devarakonda et al. (2015) conducted an observational in Chronic rheumatic heart disease with symptomatic mitral stenosis (n=110). Real-time 3D echocardiography (RT3DE) vs. 2D echocardiography (2DE) was evaluated on Detection of iatrogenic atrial septal defect (iASD) post-procedure (p=<0.0001). Real-time 3D echocardiography detected iatrogenic atrial septal defects in 85.5% of patients following percutaneous transvenous mitral commissurotomy, significantly higher than the 67.3% detected by standard 2D echocardiography.
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