Impact of multiplanar review of three-dimensional echocardiographic data on management of congenital heart disease.

Background: In patients with congenital cardiac malformations, accurate diagnosis is critical in diagnosis and management. The multiplanar review mode (MPR) allows the operator to cut three-dimensional (3D) echocardiographic data sets in infinite planes, and to review the moving image in three simultaneous orthogonal planes. We sought to describe the clinical utility of MPR of 3D echocardiography for analysis of congenitally malformed hearts.

A multiplanar three dimensional echocardiographic study of mitral valvar annular function in children with normal and regurgitant valves.

Introduction: The mitral valvar complex is difficult to visualise accurately in only two dimensions. Three-dimensional echocardiography gives new insight into the dynamic changes of intra-cardiac structures during the cardiac cycle. The aim of this study was to study the mitral annulus in systole and diastole in normal children using three-dimensional echocardiography, and to analyse the effect of regurgitation on annular function.

Determinants of outcome in fetal pulmonary valve stenosis or atresia with intact ventricular septum.

Pulmonary valve stenosis or atresia with intact ventricular septum represents a spectrum of severity. This study aimed to identify ultrasound markers of biventricular versus non-biventricular outcome. The fetal echocardiograms of 41 fetuses diagnosed with pulmonary stenosis or atresia and right ventricular (RV)/left ventricular (LV) length ratios >0.

Three-dimensional echocardiography improves the understanding of the mechanisms and site of left atrioventricular valve regurgitation in atrioventricular septal defect.

Objectives: The purpose of this study was to determine whether 3-dimensional echocardiography (3DE) provides additional information regarding the mechanisms and sites of left atrioventricular valve regurgitation in atrioventricular septal defect compared with transesophageal 2-dimensional echocardiography (2DE).

Methods: Eleven patients with a median age of 5.4 years (2.

Assessment of the evolution of normal fetal diastolic function during mid and late gestation by spectral Doppler tissue echocardiography.

Objective: To establish gestational age-specific reference values in healthy singleton fetuses, we prospectively assessed the evolution of diastolic longitudinal wall-motion velocities by spectral Doppler tissue imaging.

Methods: Early (Ea) and late diastolic (Aa) peak Doppler tissue imaging velocities were analyzed in 114 fetuses (age range: 14-42 weeks) at the base of right ventricular free wall, ventricular septum, and left ventricular free wall and compared with early (E) and late (A) diastolic peak Doppler inflow velocities.

Results: A linear increase in Ea, Aa, and Ea/Aa ratio was documented at all sites with advancing gestation.

The impact of patch augmentation on left atrioventricular valve dynamics in patients with atrioventricular septal defects: early and midterm follow-up.

Objective: Left atrioventricular valve pericardial patch may prevent valve replacement. We assessed patch annular dynamics compared with conventional repair and normal annuli.

Methods: Transesophageal 3-dimensional echocardiography was acquired preoperatively and postoperatively in atrioventricular septal defects (n = 10, 5 patch, 5 conventional repair).

Three-dimensional tricuspid annular function provides insight into the mechanisms of tricuspid valve regurgitation in classic hypoplastic left heart syndrome.

Background: Tricuspid regurgitation (TR) has a negative impact on outcome in hypoplastic left heart syndrome (HLHS). There is a paucity of data assessing the mechanisms of TR. Lateral forces from the left ventricle play an important role in normal tricuspid valve (TV) function.

Doppler tissue imaging in the assessment of atrioventricular conduction time: validation of a novel technique and comparison with electrophysiologic and pulsed wave Doppler-derived equivalents in an animal model.

Accurate assessment of atrioventricular conduction time (AVCT) is crucial for early detection of evolving fetal heart block. Simultaneous pulsed wave Doppler (PD) interrogation of left ventricular inflow and outflow is mainly used to study fetal AVCT. Limitations of this modality include its dependency on loading conditions and merging early and late diastolic inflow waves at faster heart rate (HR).

Hemodynamic evaluation of the peripheral pulmonary circulation by cine phase-contrast magnetic resonance imaging.

Purpose: To describe the normal flow patterns in peripheral pulmonary vessels with phase-contrast (PC) magnetic resonance imaging (MRI).

Materials And Methods: Twelve healthy adults (age = 33 +/- 7 years) underwent cine PC MRI of the segmental and central pulmonary arteries and veins by means of a breath-held segmented k-space technique. Flow patterns were analyzed on time-velocity curves and compared between the peripheral and central vessels.

Insight into normal mitral and tricuspid annular dynamics in pediatrics: a real-time three-dimensional echocardiographic study.

Background: Although there are animal or adult studies analyzing annular motion of the mitral valve (MV) or tricuspid valve (TV) separately, there are no data analyzing interaction between the MV and TV, or data from the pediatric population.

Methods: A total of 17 healthy children (age 3-15 years) were enrolled in this study. Using real-time 3-dimensional echocardiography, annular area, perimeter, segmental diameter, and bending angle were obtained and analyzed.

How is pulmonary arterial blood flow affected by pulmonary venous obstruction in children? A phase-contrast magnetic resonance study.

Background: Hemodynamic changes within a stenosed pulmonary vein might not reflect the severity of the obstruction if redistribution of pulmonary artery flow occurs.

Objective: The purpose was to investigate flow changes in branch pulmonary arteries in the presence of pulmonary vein stenosis.

Materials And Methods: Twelve children (age range 3-180 months) who had undergone MRI for pulmonary vein stenosis were identified.

Comparative imaging of differential pulmonary blood flow in patients with congenital heart disease: magnetic resonance imaging versus lung perfusion scintigraphy.

Background: Lung perfusion scintigraphy is considered the gold standard to assess differential pulmonary blood flow while magnetic resonance (MR) has been shown to be an accurate alternative in some studies.

Objective: The purpose of the study was to assess the accuracy of phase contrast magnetic resonance (PC-MR) in measuring pulmonary blood flow ratio compared with lung perfusion scintigraphy in patients with complex pulmonary artery anatomy or pulmonary hypertension and to document reasons for discrepant results.

Materials And Methods: We identified 25 cases of congenital heart disease between January 2000 and 2003, in whom both techniques of assessing pulmonary blood flow were performed within a 6-month period without an interim surgical or transcatheter intervention.

Different techniques for closure of multiple interatrial communications with the Amplatzer septal occluder.

We present three cases of multiple interatrial communications to illustrate the extended use of the Amplatzer septal occluder and to highlight procedural techniques. The first case demonstrates how a single device can be used to close two adjacent defects. It is important to balloon size both defects and to note if balloon occlusion of one defect closes the other and vice versa.

Obstructed hemianomalous pulmonary venous drainage: is intervention necessary?

Obstructed infradiaphragmatic hemianomalous pulmonary venous drainage is associated with high mortality and morbidity, and treatment is best tailored to the individual patient. Resolution of an obstructed scimitar vein through collateralization has rarely been reported. We report two such cases and review the literature.