Intraoperative Three-dimensional Imaging of Ventricular Septal Defects in Children Using Epicardial Echocardiography: A Novel Approach

Manjusha N Pillai; Puthuvassery Raman Suneel; Sabarinath Menon; Koniparambil Papu Unnikrishnan; Sudip Dutta Baruah; Thomas Mathew; Sriram Pravin Lovhale; Baiju S Dharan

doi:10.1053/j.jvca.2020.10.051

Intraoperative Three-dimensional Imaging of Ventricular Septal Defects in Children Using Epicardial Echocardiography: A Novel Approach

J Cardiothorac Vasc Anesth. 2021 Oct;35(10):2892-2899. doi: 10.1053/j.jvca.2020.10.051. Epub 2020 Oct 29.

Authors

Manjusha N Pillai¹, Puthuvassery Raman Suneel², Sabarinath Menon³, Koniparambil Papu Unnikrishnan¹, Sudip Dutta Baruah³, Thomas Mathew³, Sriram Pravin Lovhale¹, Baiju S Dharan³

Affiliations

¹ Department of Cardiac Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
² Department of Cardiac Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. Electronic address: suneelpr@gmail.com.
³ Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

PMID: 33234468
DOI: 10.1053/j.jvca.2020.10.051

Abstract

Objective: To assess the feasibility and accuracy of intraoperative three-dimensional (3D) epicardial en face images of ventricular septal defects (VSD) in children using the 3D transesophageal echocardiography (TEE) probe as an epicardial probe.

Design: This was a prospective nonrandomized blinded observational study.

Setting: The study was conducted at a single tertiary cardiac care center.

Participants: Fifty pediatric patients, weighing between 5.0 kg and 20 kg, who were scheduled for elective surgical closure of their VSDs, prospectively were recruited for this study.

Interventions: Epicardial 3D images were acquired using the full-volume mode. VSD location and size were determined from the 3D data sets using multiplanar reconstruction mode (QLAB 9) by a blinded investigator. The accuracy in terms of location and size was compared with surgical findings.

Measurements and main results: In 50 study subjects, 54 VSDs were located by epicardial 3D echocardiography (3DE): 12 perimembranous, 17 inlet, eight muscular, 15 malaligned, and two outlet. Average image acquisition time was 4.96 (±1.47) minutes. Average image reconstruction time was 6.18 (±1.93) minutes. Good en face views of the VSD could be rendered in all patients (100% feasibility). The highest image quality was for perimembranous and malaligned VSDs. The location of VSD by 3DE corresponded precisely with surgical findings (100% accuracy). With linear regression analysis, excellent correlation was observed between the diameters measured by surgery and that measured by 3DE from the right ventricle side (r² = 0.97, p < 0.001).

Conclusions: The authors' study demonstrated that diagnostic quality 3D en face images of VSD can be obtained intraoperatively using 3D epicardial echocardiography. The short acquisition and reconstruction times make this technique clinically applicable.

Keywords: congenital heart disease; epicardial echocardiography; three-dimensional echocardiography; ventricular septal defect.

Publication types

Observational Study

MeSH terms

Child
Echocardiography
Echocardiography, Three-Dimensional*
Echocardiography, Transesophageal
Heart Septal Defects, Ventricular* / diagnostic imaging
Heart Septal Defects, Ventricular* / surgery
Humans
Prospective Studies