New insights and observations in three dimensional echocardiographic visualization of ventricular septal defects: Left ventricular en face views

Richard Kardon, Navroz Masani, Jiefen Yao, Natesa Pandian, Gerald Marx

Research output: Contribution to journalArticlepeer-review


We have previously validated the accuracy of three-dimensional echocardiography (3DE) for determining the position and size of VSDs in an in-vitrv model. Purpose: the objective of this study was to develop methodology to best depict the size, shape and position of VSDs by 3DE in pediatric pts. Methods: We examined 22 pts, median age 11 months, (10 days to 7 years) with membranous (MEMB), muscular (MUSQ and doubly committed (DC) VSDs. 3DE acquisitions were performed using the transthoracic (18 pts) or transesophageal (4 pts) approach and data was digitally reformatted for 3D reconstruction using a PObased computer (TomTec EchoScan). Images were analyzed by a blinded observer and compared with 2D echo, cath, and surgical data. The major and minor perpendicular axes were measured to assess VSD size and shape. Results: We found that a left sided en-face "three-chamber" view produced the best unobstructed view or the entire interventricular septum. Satisfactory reconstructions were obtained in 19 of 22 pts. Direct visualization of the VSD was possible in these 19 pts allowing precise determination of their size, shape, number and position as relates to the LV septum, aortic and mitral valves: 12 were MEMB, 6 were MUSC (2 multiple), 2 were both MEMB and MUSC and 2 were DC The major and minor axis measurements by 3DE were 7±2.6mm and 5±1.8mm respectively. In 14pts, the long:short axis ratio was ≥1.3, implying an oval shape. In 4 pts with surgical measurements, 3DE dimensions compared well. In 2 pts, clear depiction of the relation between VSD and aorta resulted in reclassification of MEMB to high MUSC defects. 3DE identified the individual defects in 2 pts with multiple MUSC VSDs which had not been seen with conventional imaging. The relationship of the VSD to the anterior or posterior septum could be appreciated precisely using this en face view. Two potential sources of error were observed. In 2 pts tangential views of the septum obscured the VSD. In 1 pt, echo dropout gave the impression of additional VSDs. Conclusion: 3DE en face LV projections provided unique visualization of MEMB, MUSC and DC VSDs allowing precise determination of the site, size and number of defects. This may have important applications in surgical closure of multiple VSDs, or catheter-based device closure.

Original languageEnglish (US)
Number of pages1
JournalJournal of the American Society of Echocardiography
Issue number4
StatePublished - Dec 1 1997
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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