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Echocardiographic assessment of left to right shunts: atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent arterial duct

Abstract

This review article will guide the reader through the basics of echocardiographic assessment of congenital left to right shunts in both paediatric and adult age groups. After reading this article, the reader will understand the pathology and clinical presentation of atrial septal defects (ASDs), ventricular septal defects (VSDs), atrioventricular septal defects (AVSDs) and patent arterial duct. Echocardiography is the mainstay in diagnosis and follow-up assessment of patients with congenital heart disease. This article will therefore describe the echocardiographic appearances of each lesion, and point the reader towards specific features to look for echocardiographically.

References

  1. Hoffman JIE. The global burden of congenital heart disease. Cardiovascular Journal of Africa 201324 141–145. https://doi.org/10.5830/CVJA-2013-028)

    Article  PubMed  PubMed Central  Google Scholar 

  2. Levin AR, Spach MS, Boineau JP, Canent RV Jr, Capp MP & Jewett PH. Atrial pressure-flow dynamics in atrial septal defects (secundum type). Circulation 196837 476–488. https://doi.org/10.1161/01.CIR.37.4.476)

    Article  CAS  PubMed  Google Scholar 

  3. Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW & Geva T. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. Journal of the American Society of Echocardiography 201023 465–495. https://doi.org/10.1016/j.echo.2010.03.019)

    Article  PubMed  Google Scholar 

  4. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK & Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography. Journal of the American Society of Echocardiography 201023 685–713. https://doi.org/10.1016/j.echo.2010.05.010)

    PubMed  Google Scholar 

  5. Helbing WA, Bosch HG, Maliepaard C, Rebergen SA, van der Geest RJ, Hansen B, Ottenkamp J, Reiber JH & de Roos A. Comparison of echocardiographic methods with magnetic resonance imaging for assessment of right ventricular function in children. American Journal of Cardiology 199576 589–594. https://doi.org/10.1016/S0002-9149(99)80161-1)

    Article  CAS  PubMed  Google Scholar 

  6. Alghamdi MH, Grosse-Wortmann L, Ahmad N, Mertens L & Friedberg MK. Can simple echocardiographic measures reduce the number of cardiac magnetic resonance imaging studies to diagnose right ventricular enlargement in congenital heart disease? Journal of the American Society of Echocardiography 201225 383–384. https://doi.org/10.1016/j.echo.2011.12.022)

    Article  Google Scholar 

  7. Gopal AS, Chukwu EO, Iwuchukwu CJ, Katz AS, Toole RS, Schapiro W & Reichek N. Normal values of right ventricular size and function by real-time 3-dimensional echocardiography: comparison with cardiac magnetic resonance imaging. Journal of the American Society of Echocardiography 200720 445–455. https://doi.org/10.1016/j.echo.2006.10.027)

    Article  PubMed  Google Scholar 

  8. Lu X, Nadvoretskiy V, Bu L, Stolpen A, Ayres N, Pignatelli RH, Kovalchin JP, Grenier M, Klas B & Ge S. Accuracy and reproducibility of real-time three-dimensional echocardiography for assessment of right ventricular volumes and ejection fraction in children. Journal of the American Society of Echocardiography 200821 84–89. https://doi.org/10.1016/j.echo.2007.05.009)

    Article  PubMed  Google Scholar 

  9. Jenkins C, Chan J, Bricknell K, Strudwick M & Marwick TH. Reproducibility of right ventricular volumes and ejection fraction using real-time three-dimensional volumes using real-time three-dimensional echocardiography: comparison with cardiac MRI. Chest 2007131 1844–1851. https://doi.org/10.1378/chest.06-2143)

    Article  PubMed  Google Scholar 

  10. Rufino Nascimento IG, Dehant P, Jimenez M, Dequeker JL, Castela E & Choussat A. Calculation of the pulmonary to systemic flow ratio using echo-Doppler in septal defects-correlation with oximetry. Revista Portuguesa de Cardiologia 19898 35–40.

    CAS  PubMed  Google Scholar 

  11. Schubert S, Peters B, Abdul-Khaliq H, Nagdyman N, Lange PE & Ewert P. Left ventricular conditioning in the elderly patient to prevent congestive heart failure after transcatheter closure of atrial septal defect. Catheterization and Cardiovascular Interventions 200564 333–337. https://doi.org/10.1002/ccd.20292)

    Article  CAS  PubMed  Google Scholar 

  12. Anderson RH. Interatrial communications. In Paediatric Cardiology, 3rd edn., ch 25, p 529. Eds, Anderson RH, Baker EJ, Penny DJ, Redington AN, Rigby ML &, Wernovsky G. Philadelphia, PA, USA: Churchill Livingstone, 2010.

    Google Scholar 

  13. McCarthy K, Ho S & Anderson R. Defining the morphology phenotypes of atrial septal defects and interatrial communications. Images in Paediatric Cardiology 20035 1–24.

    PubMed  PubMed Central  Google Scholar 

  14. Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Journal of the American Society of Echocardiography 201326 921–964. https://doi.org/10.1016/j.echo.2013.07.009)

    Article  PubMed  Google Scholar 

  15. Silvestry F, Cohen M, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, Lang RM, Rome JJ & Wang Y. Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale: from the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. Journal of the American Society of Echocardiography 201528 910–958. https://doi.org/10.1016/j.echo.2015.05.015)

    Article  PubMed  Google Scholar 

  16. Abaci A, Unlu S, Alsancak Y, Kaya U & Sezenoz B. Short and long term complications of device closure of atrial septal defect and patent foramen ovale: meta analysis of 28,142 patients from 203 studies. Catheterization and Cardiovascular Interventions 201382 1123–1138. https://doi.org/10.1002/ccd.24875)

    Article  PubMed  Google Scholar 

  17. Young D. Later results of closure of secundum atrial septal defect in children. American Journal of Cardiology 197331 14–22. https://doi.org/10.1016/0002-9149(73)90804-7)

    Article  CAS  PubMed  Google Scholar 

  18. Bricker JT, Gillette PC, Cooley DA & McNamara DG. Dysrhythmias after repair of atrial septal defect. Texas Heart Institute Journal 198613 203–208.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Lewis DA, Loffredo CA, Correa-Villaseñor A, Wilson PD & Martin GR. Descriptive epidemiology of membranous and muscular ventricular septal defects in the Baltimore-Washington Infant Study. Cardiology in the Young 19966 281–290.

    Article  Google Scholar 

  20. Anderson RH. Ventricular septal defects. In Paediatric Cardiology, 3rd edn., ch 28, pp 594–605. Eds, Anderson RH, Baker EJ, Penny DJ, Redington AN, Rigby ML &, Wernovsky G. Philadelphia, PA, USA: Churchill Livingstone, 2010.

    Google Scholar 

  21. McCarthy KP, Ho SY & Anderson RH. Categorisation of ventricular septal defects: review of the perimembranous morphology. Images in Paediatric Cardiology 20002 24–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. Jacobs JP, Burke RP, Quintessenza JA & Mavroudis C. Congenital heart surgery nomenclature and database project: ventricular septal defect. Annals of Thoracic Surgery 200069 S25–S35. https://doi.org/10.1016/S0003-4975(99)01270-9)

    Article  CAS  PubMed  Google Scholar 

  23. Forbus GA & Shirali GS. Anomalies of the ventricular septum. In Echocardiography in Paediatric and Congenital Heart Disease from Fetus to Adult, 1st ed., ch 12, p 180. Eds, Lai WW, Mertens LL, Cohen MS &, Geva T. Hoboken, NJ, USA: John Wiley & Sons Ltd, 2009.

    Google Scholar 

  24. Hoffman JI & Kaplan S. The incidence of congenital heart disease. JACC: Journal of the American College of Cardiology 200239 1890–1900. https://doi.org/10.1016/S0735-1097(02)01886-7)

    Article  PubMed  Google Scholar 

  25. Bergstöm S, Carr H, Petersson G, Stephansson O, Edstedt Bonamy AK, Dahlström A, Pegelow Halvorsen C & Johansson S. Trends in congenital heart defects in infants with Down syndrome. Pediatrics 2016138 e20160123.

    Article  Google Scholar 

  26. Ebels T, Elzenga N & Anderson RH. Atrioventricular septal defects. In Paediatric Cardiology, 3rd ed., ch 27, pp 560–564. Eds, Anderson RH, Baker EJ, Penny DJ, Redington AN, Rigby ML &, Wernovsky G. Philadelphia, PA, USA: Churchill Livingstone, 2010.

    Google Scholar 

  27. Draulans-Noë HA, Wenink AC & Quaegebeur J. Single papillary muscle (“parachute valve”) and double-orifice ventricle in atrioventricular septal defects convergence of chordal attachments: surgical anatomy and results of surgery. Pediatric Cardiology 199011 29–35.

    Article  PubMed  Google Scholar 

  28. Jegatheeswaran A, Pizarro C, Caldarone CA, Cohen MS, Baffa JM, Gremmels DB, Mertens L, Morrell VO, Williams WG & Blackstone EH, et al. Echocardiographic definition and surgical decision-making in unbalanced atrioventricular septal defect. Circulation 2010122 S209–S215. https://doi.org/10.1161/CIRCULATIONAHA.109.925636)

    Article  PubMed  Google Scholar 

  29. Cohen MS, Jegatheeswaran A, Baffa JM, Gremmels DB, Overman DM, Caldarone CA, McCrindle BW & Mertens L. Echocardiographic features defining right dominant unbalanced atrioventricular septal defect. A multi-institutional Congenital Heart Surgeons’ Society Study. Circulation: Cardiovascular Imaging 20136 508–513.

    Google Scholar 

  30. Devlin PJ, Backer CL, Eltayeb O, Mongé MC, Hauck AL & Costello JM. Repair of partial atrioventricular septal defect: age and outcomes. Annals of Thoracic Surgery 2016102 170–177. https://doi.org/10.1016/j.athoracsur.2016.01.085)

    Article  PubMed  Google Scholar 

  31. Bowman JL, Dearani JA, Burkhart HM, Goodloe AH, Phillips SD, Weaver AL, Eidem BW & Cetta F. Should repair of partial atrioventricular septal defect be delayed until later in childhood? American Journal of Cardiology 2014114 463–467. https://doi.org/10.1016/j.amjcard.2014.05.020)

    Article  PubMed  Google Scholar 

  32. Schneider DJ & Moore JW. Patent ductus arteriosus. Circulation 2006114 1873–1882. https://doi.org/10.1161/CIRCULATIONAHA.105.592063)

    Article  PubMed  Google Scholar 

  33. Johnson GL, Breart GL, Gewitz MH, Brenner JI, Lang P, Dooley KJ & Curtis Ellison R. Echocardiographic characteristics of premature infants with patent ductus arteriosus. Pediatrics 198372 864–871.

    Article  CAS  PubMed  Google Scholar 

  34. Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Journal of the American Society of Echocardiography 201225 3–46. https://doi.org/10.1016/j.echo.2011.11.010)

    Article  PubMed  Google Scholar 

  35. Simpson J, Lopez L, Acar P, Friedberg MK, Khoo NS, Ko HH, Marek J, Marx G, McGhie JS, Meijboom F, et al. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Journal of the American Society of Echocardiography 201730 1–27. https://doi.org/10.1016/j.echo.2016.08.022)

    Article  PubMed  Google Scholar 

  36. Cossor W, Cui VW & Roberson DA. Three-dimensional echocardiography en face views of ventricular septal defects: feasibility, accuracy, imaging, protocols and reference image collection. Journal of the Americal Society of Echocardiography 201528 1020–1029. https://doi.org/10.1016/j.echo.2015.05.014)

    Article  Google Scholar 

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Correspondence to Antigoni Deri MD.

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Deri, A., English, K. Echocardiographic assessment of left to right shunts: atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent arterial duct. Echo Res Pract 5, R1–R16 (2018). https://doi.org/10.1530/ERP-17-0062

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