A 51-year-old female with exertional dyspnea was admitted. Transthoracic echocardiography (TTE) revealed 2 defects at interatrial septum with left to right shunt (Fig. 1A). En face display of the interatrial septum by three-dimensional (3D) TTE demonstrated two ovoid atrial septal defects (ASDs). Two ovoid defects and interatrial septum formed like horseshoe (Fig. 1B). Transesophageal echocardiography (TEE) revealed total three oval shaped ASDs, which were well-visualized in one view, using 3D volume rendering of the interatrial septum from real-time 3D data (Fig. 2A). This finding was consistent with an intraoperative image (Fig. 2B).
3D TEE has a distinct advantage over two-dimensional (2D) echocardiography in case of complex ASD, especially when 2 or more defects are present.1)2) 3D echocardiography can provide more accurate images allowing adequate preoperative surgical planning. The present case suggested that morphologically complex ASDs can be more thoroughly characterized with 3D TEE, and more detailed information can be provided, comparing with 2D echocardiography.
References
1. Taniguchi M, Akagi T, Kijima Y, Sano S. Clinical advantage of real-time three-dimensional transesophageal echocardiography for transcatheter closure of multiple atrial septal defects. Int J Cardiovasc Imaging. 2013; 29:1273–1280.
2. Roberson DA, Cui W, Patel D, Tsang W, Sugeng L, Weinert L, Bharati S, Lang RM. Three-dimensional transesophageal echocardiography of atrial septal defect: a qualitative and quantitative anatomic study. J Am Soc Echocardiogr. 2011; 24:600–610.