Khaled Hadeed

Comparison of two- and three-dimensional transthoracic echocardiography for measurement of aortic annulus diameter in children

BACKGROUND Accurate evaluation of aortic root geometry is necessary in congenital aortic valve lesions in children, to guide surgical or angiographical intervention. AIM To compare aortic annulus diameters measured by two- and three-dimensional transthoracic echocardiography (2D- and 3D-TTE), to determine the feasibility and reproducibility of 3D imaging and assess the dynamic changes during the cardiac cycle. METHODS Thirty children without heart disease were prospectively included. Two orthogonal aortic annulus diameters were measured offline using multiplanar reconstruction in diastole and in systole and were compared with the measurement of the aortic annulus diameter by 2D-TTE. RESULTS Mean age was 11±3.6 years. Feasibility of 3D imaging was 100%. The coefficients of intra- and interobserver variability were 3.5% and 6%, respectively. The 2D mean diameter was significantly smaller than the 3D maximum diameter in systole (1.94 vs. 2.01mm; p=0.005). 2D and 3D measurements were well correlated (p<0.0001). The maximum and minimum diameters in 3D were significantly different both in systole and in diastole (p<0.001) underlining an aortic annulus eccentricity. The mean aortic annulus diameters were not significantly different between systole and diastole, with important individual variability during the cardiac cycle. CONCLUSION This study demonstrated the feasibility and reproducibility of 3D-TTE for the assessment of the aortic annulus diameter in a normal paediatric population. Because of an underestimation of the maximum diameter by 2D-TTE and the asymmetry of the aortic annulus, 3D measurements could be important before percutaneous aortic valvuloplasty or surgical replacement.

Three-dimensional printing of a complex CHD to plan surgical repair.

We used three-dimensional printing technology to create an anatomical three-dimensional model of a very rare and complex cyanotic CHD in a newborn, consisting of double-outlet left ventricle, ventricular septal defect, and pulmonary stenosis. This case demonstrates how this new innovative technology allows better understanding of the anatomy in complex CHDs and permits to better plan the surgical repair.

3D transthoracic echocardiography to assess pulmonary valve morphology and annulus size in patients with Tetralogy of Fallot.

BACKGROUND Accurate evaluation of the pulmonary valve (PV) is crucial before surgical repair of Tetralogy of Fallot (TOF). AIMS To assess PV and pulmonary annulus (PA) morphology using three-dimensional (3D) transthoracic echocardiography (TTE) in infants referred for surgical repair of TOF. Also, to compare PA measurements obtained by 3D TTE with those from other imaging modalities, including two-dimensional (2D) TTE and computed tomography (CT), with reference to surgical measurements. METHODS 3D zoom mode was used to assess PV morphology. 2D TTE and CT PA diameters were compared to both vertical and horizontal diameters obtained from 3D datasets. Surgical PA diameters were measured using Hegars dilators. RESULTS A total of 29 patients with TOF (median [range] age 6 [3-24] months) were included and all successfully underwent 2D and 3D TTE; 22 also underwent CT. The number of pulmonary leaflets could be visualized in 24 patients (82.8%), with complete concordance with surgical findings. Vertical diameter was significantly longer than horizontal diameter (P<0.001)-underlying PA eccentricity-and was more important in bicuspid than tricuspid valves. Correlations between 2D and 3D TTE diameters were good. Surgical diameter was better correlated with 2D and 3D diameters than with CT diameter. 3D minimum, 2D and CT diameters were significantly lower than surgical diameters, but 3D mean and maximum diameters were not. CONCLUSION 3D TTE is accurate to assess PV morphology and PA size in patients with TOF. 2D TTE and CT underestimate PA diameter with reference to surgical diameter, however 3D mean and maximum diameters did not differ significantly.

Tethering of Tricuspid Valve Resulting from Aberrant Tendinous Cords Mimic Ebstein's Anomaly, Three‐Dimensional Echocardiography Approach

A neonate with refractory cyanosis, respiratory distress, and severe cardiomegaly was referred to our institution for suspicion of Ebstein’s anomaly. The electrocardiogram (Nihon Kohden, Tokyo, Japan) showed right atrial enlargement with incomplete right bundle branch block without preexcitation. Chest radiography revealed extreme cardiomegaly with decrease pulmonary vascularity. Two-dimensional echocardiography (2DE) revealed right atrial enlargement, tethering of tricuspid valve (TV), dilated TV annulus with severe regurgitation, and right to left shunt through a large atrial septal defect. We used real time three-dimensional echocardiography (RT3DE) Philips iE33 system (Andover, MA, USA), to assess more precisely the mechanism of the TV regurgitation; the region of ineffective coaptation was well visualized using the en face view. The movements of the septal and inferior leaflets were restricted by aberrant tendinous cords, (Figs. 1 and 2). The postprocessing analysis of the 3D volume dataset by multiplanar review mode (QLab 9, Philips, Andover, MA, USA) allowed visualization of the normal delamination of the septal and inferior leaflets without apical displacement of their hinge points (Fig. 3). The aberrant tendinous cords were clearly identified by sliding the planes throughout the leaflets.

Multimodal imaging and three-dimensional cardiac computational modelling in the management of congenital heart disease: The secret to getting ahead is to get started

On 28 December 1895, a crowd milled outside the Grand Café in Paris for a mysterious exhibition. For 1 Franc, promoters promised, the audience would witness the first ‘‘living photographs’’ in history. The grainy footage of women emerging from the shadows of a factory is laughably primitive today, but in the Grand Café basement in central Paris that night, the audience gasped, applauded, and laughed. Some simply sat, dumbfounded. At that moment, brothers Auguste and Louis Lumière screened the first moving picture, or movie, in history. Paris embraced the world’s most famous museums and art galleries, alongside a thriving community of artists. Movies —– considered as the ‘‘Seventh Art’’ —– grew up alongside painting and sculpture. Movies were initially scorned, being considered a minor form of art, but opinion has since e t a f

Feasibility of New Transthoracic Three-Dimensional Echocardiographic Automated Software for Left Heart Chamber Quantification in Children

Background: New three‐dimensional echocardiographic automated software (HeartModel) is now available to quantify the left heart chambers. The aims of this study were to assess the feasibility, reproducibility, and analysis time of this technique and its correlation with manual three‐dimensional echocardiography (3DE) and cardiac magnetic resonance (CMR) in children. Methods: Ninety‐two children (5–17 years of age) were prospectively included in two separate protocols. In protocol 1, 73 healthy children underwent two‐dimensional and three‐dimensional transthoracic echocardiography. Left ventricular (LV) end‐diastolic volume (LVEDV), LV end‐systolic volume (LVESV), LV ejection fraction (LVEF), and left atrial volume at ventricular end‐systole (LAV) by automated 3DE were compared with the same measurements obtained using manual 3DE. In protocol 2, automated three‐dimensional echocardiographic measurements from 19 children with cardiomyopathy were compared with CMR values. Results: Automated 3DE was feasible in 77% of data sets and significantly reduced the analysis time compared with manual 3DE. In protocol 1, there were excellent correlations for LVEDV, LVESV, and LAV between automated 3DE and manual 3DE (r = 0.89 to 0.99, P < .0001 for all) and a weak correlation for LVEF, despite contour adjustment (r = 0.57, P < .0001). Automated 3DE overestimated LVEDV, LVEF, and LAV with small biases and underestimated LVESV with wider bias. With contour adjustment, the biases and limits of agreement were reduced (bias: LVEDV, 0.9 mL; LVESV, −1.2 mL; LVEF, 2.2%). In protocol 2, correlations between automated 3DE with contour edit and CMR were good for LV volumes and LAV (r = 0.76 to 0.94, P < .0003 for all) but remained weak for LVEF (r = 0.46, P = .05). Automated 3DE slightly underestimated LV volumes (relative bias, −7.2% to −7.8%) and significantly underestimated LAV (relative bias, −31.6%). The limits of agreement were clinically acceptable only for LVEDV. Finally, test‐retest, intraobserver, and interobserver variability values were low (<12%). Conclusions: HeartModel is feasible, reproducible, faster than manual 3DE, and comparable with manual 3DE for measurements of LV and left atrial volumes in children >5 years of age. However, compared with CMR, only LVEDV measured by automated 3DE with contour edit seems applicable for clinical practice. HIGHLIGHTSAutomated 3DE is feasible, reproducible and fast in children.Correlation for LV and LA volumes between automated 3DE and manual 3DE is excellent.Correlation for LV and LA volumes between automated 3DE and CMR is good.Correlation for LVEF by automated 3DE against manual 3DE and CMR is weak.Good precision is obtained only for LVEDV by automated 3DE with contour edit.

Interventional catheterization and echocardiography: An indefectible link illustrated by atrial septal defect closure

asson SAS.All rights reserved. Document downloaded on 26/01/2020 It is forbidden and illegal t maging was available to define simple cardiac structures 1], then technology improved to provide two-dimensional 2D) real-time imaging of the heart and Doppler, which subequently revolutionized non-invasive assessment. By the ate 1980s, echocardiography had developed to the point here it began to replace cardiac catheterization as the priary diagnostic tool for congenital heart disease, reducing he number of cardiac catheterizations. Interventional cardiac catheterization was launched by r Gruntzig, with the first coronary angioplasty, and its evelopment continued with Dr Porstmann’s use of an VALON ® (First Aid Bandage Co., New London, CT, USA) plug o close persistent patent ductus arteriosus, and Dr King’s evices for the closure of secundum atrial septal defects ASDs) [2] to rescue cardiac catheterization. Nevertheless, echnical difficulties (i.e. limited retrievability and large elivery systems) and residual shunts plagued the develpment of these devices, and their application remained imited.

Isolated severe leftward displacement of the septum primum: anatomic and 3D echocardiographic findings and surgical repair

OBJECTIVES Leftward displacement of the septum primum is usually described as associated with hypoplastic left heart syndrome or visceral heterotaxy. This rare malformation results in partially or totally anomalous pulmonary venous drainage with a normal connection of the pulmonary veins to the left atrium, depending on the degree of septal shift. We report the 3D echocardiographic and anatomic findings as well as the surgical repair in a series of isolated severe leftward displacement of the septum primum, responsible for totally anomalous pulmonary venous drainage. METHODS Three patients presenting with situs solitus and extreme leftward displacement of the septum primum were included. All of the pulmonary veins drained anomalously into the anatomical right atrium, and the distance between the mitral valve and the abnormal septum primum was greatly reduced, compromising the size of the left atrial chamber, but with normal left ventricle diameters. Preoperative 3D echocardiographic findings are reported. We achieved a biventricular surgical repair in all cases. The atrial septation was accomplished using an autologous pericardial patch after removing the abnormal septal membrane. RESULTS The postoperative course was free from any cardiovascular complications. Echocardiographic scans showed a harmonious reconstruction without pulmonary venous obstructions or stenosis. CONCLUSIONS This article reports the severe leftward displacement of the septum primum presented as an isolated cardiac malformation; 3D transthoracic echocardiography allowed an accurate diagnosis of this malformation and helped in choosing the best surgical strategy.

Image of a left atrial mass after a cardiopulmonary bypass in a child

Invagination of an appendage into the left atrium is a rare complication. It occurs spontaneously or after open‐heart surgery. In our case, a postoperative transesophageal echocardiogram, after closure of a ventricular septal defect in a 5‐month‐old infant, revealed a large mass in the left atrium. A diagnosis of a left appendage inversion was confirmed after external examination of the heart. Herein, we provide echocardiographic images before, during, and after manual reversion of the left appendage. Misdiagnosis of this complication could have led to an additional unnecessary surgical procedure that could have impacted on the patients morbidity.

Two-dimensional right ventricular strain by speckle tracking for assessment of longitudinal right ventricular function after paediatric congenital heart disease surgery.

BACKGROUND Right ventricular (RV) function is a prognostic marker of cardiac disease in children. Speckle tracking has been developed to assess RV longitudinal shortening, the dominant deformation during systole; little is known about its feasibility in children with congenital heart disease (CHD). AIMS To evaluate the feasibility and reproducibility of RV two-dimensional (2D) strain assessed by speckle tracking in infants undergoing CHD surgery compared with conventional markers. METHODS In this prospective single-centre study, RV peak systolic strain (RV-PSS) was measured using 2D speckle tracking in 37 consecutive children undergoing CHD surgery. Examinations were performed the day before surgery, a few hours after surgery and before discharge. Relationships with the z score of tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TA Sa) were assessed. RESULTS Median (interquartile range) age was 19 months (5-63); median weight was 9.2 kg (5.3-18.0). RV-PSS analysis was feasible in 92.9% (95% confidence interval [CI]: 86.0-97.1) of examinations. The coefficient of variation was 9.7% (95% CI: 7.4-11.9) for intraobserver variability and 15.1% (95% CI: 12.7-17.6) for interobserver variability. Correlations between RV-PSS and z score of TAPSE and TA Sa were strong (r=0.71, P<0.0001 and r=0.70, P<0.0001, respectively). RV-PSS was significantly reduced after surgery compared with baseline (-10.5±2.9% vs. -19.5±4.8%; P<0.0001) and at discharge (-13.5±4.0% vs. -19.5±4.8%; P<0.0001). Similar evolutions were observed with TAPSE and TA Sa (both P<0.0001). CONCLUSION RV longitudinal strain by speckle tracking is a feasible and reproducible method of assessing perioperative evolution of RV function in children with CHD.