الفهرس 
Clinical ManifestationsOnly 14 pages are availabe for public view
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Abstract
Functional and morphologic assessment of VSD is routinely done with 2-dimensional (2D) and color Doppler echocardiography. Usually, this provides adequate information to decide on surgical repair. Nevertheless, the anatomy of the VSD is complex and cannot be presented by actual imaging techniques in a single plane(38, 39).
Furthermore, advances in cardiac surgical procedures and introduction of percutaneous device closure increasingly demand support of highly accurate imaging techniques. 3D echocardiography has been proposed as a new technique able to simulate the intra operative visualization of cardiac structures and to improve the understanding of the anatomy of congenital heart diseases(129-131). However, as with any emerging technology, the enthusiasm to embrace a new technique must be tempered by a critical appraisal of the evidence supporting its use. It is essential to assess the limitations as well as the unique capabilities it provides.
In this study, our aim was to assess the feasibility and the value of real time 3- dimensional echocardiography (RT-3DE) to accurately identify and characterize the morphology of the VSD and assess its geometry and size.
The current study was conducted on 20 patients with congenital ventricular septal defect referred to the Cardiology department at Ain Shams University Hospitals for preoperative assessment of VSD. All patients were subjected to full 2D echocardiogram using sequential analysis to establish the diagnoses as well as assess LV dimensions and functions. Real time 3D echocardiogram (RT3DE) was performed using a commercial scanner (iE33, Philips Medical Systems) equipped with a fully sampled matrix array transducer. The displaying mode of RT-3DE includes 3D Live and Full Volume and color Doppler mapping. RT3DE data sets were acquired using wide-angled acquisition mode with minimal possible depth to achieve a high frame rate. RT3DE data sets were stored digitally, analyzed by the quantification lab (Q Lab) and the full volume set was cropped in various planes to assess VSD morphology including site, number, size, shape and relation to other structures.
Intra operative findings for the patients who underwent surgical repair were recorded. The data obtained from both 2D and 3D echocardiography were compared to each other and with the surgical findings as the gold standard.
In the 20 patients, it was possible to reconstruct a VSD with complete borders from the RV enface view in 19 patients (95%) and from the LV enface view in 17 patients (85%) due to the presence of overriding of the aorta which led to the presence of incomplete borders in the remaining patients.
The current study showed that there was complete agreement as regard the number and morphology of the VSD between RT-3DE and surgical findings, the shape of VSD was well delineated after acquisition of full volume data set and cropping. The VSD shape could be seen from both the RV and LV perspective (en face view).
There was no significant difference between RT-3DE and surgery in determination of the site of VSD; (P-value = 0.059) with a percentage of agreement between the two methods of 93.33%. This percentage of agreement DROPped to 86.6% when comparing 2D echocardiography findings and surgery.
This study showed that there was an excellent correlation between VSD diameter assessed by surgery and RT-3DE either from LV enface view(r =0.948) or from RV enface view (r =0.938).This correlation was poorer when 2DE was compared with surgery (r =0.724).
This study showed that there was a significant change in the size of VSD during the cardiac cycle because there was a significant difference between end diastolic and end systolic maximum diameter (P-value was >0.001).