Marianne Peyre

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.

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.

0474: Inner architecture of the right ventricle: the role of the tricuspid valve

A major anatomic characteristic of the right ventricle (RV), in addition to coarse and few apical trabeculations, is the presence of muscular bands arranged in a semicircular fashion: parietal band and subpulmonary conus, septal band (SB), moderator band (MB). The embryologic origin of SB, MB and anterior papillary muscle of the tricuspid valve (APM) is still controversial: primitive muscular tricuspid gully, or condensation of the ventricular trabeculations. In order to determine if the presence of SB, MB and APM could be related with the degree of development of the tricuspid valve, we reviewed 32 postnatal and 26 fetal human heart specimens with tricuspid atresia (TA). Forty-two hearts had ventriculo-arterial concordance, 14 had D-transposition. There were 52 muscular TA (musTA, including 6 without any RV cavity), and 6 membranous TA (mbTA) with imperforate valvar tissue in the floor of the right atrium. All 52 hearts with a RV cavity had a well-developed ventriculo-infundibular fold (VIF). A rudimentary SB (with demonstrable limbs in 3) was present in 6/46 (13%) musTA vs 6/6 (100%) mbTA (p=0.000), rudimentary MB in 3/46 (6.5%) musTA vs 6/6 (100%) mbTA (p=0.000), rudimentary APM in 3/46 (6.5%) musTA vs 3/6 (50%) mbTA (p Conclusion SB and MB are absent in the vast majority of hearts with musTA but are found in all mbTA, while VIF is always present. These anatomic findings confirm the hypothesis of the muscular tricuspid primordium, itself developed from the posterior part of the primary fold, at the origin of SB, MB and AMP, while the VIF has a different origin (the inner curvature of the heart).