Quantification of the area and shunt volume of multiple, circular, and noncircular ventricular septal defects: A 2D/3D echocardiography comparison and real time 3D color Doppler feasibility determination study

Echocardiography. 2018 Jan;35(1):90-99. doi: 10.1111/echo.13742. Epub 2017 Oct 29.

Abstract

Background: Quantification of defect size and shunt flow is an important aspect of ventricular septal defect (VSD) evaluation. This study compared three-dimensional echocardiography (3DE) with the current clinical standard two-dimensional echocardiography (2DE) for quantifying defect area and tested the feasibility of real time 3D color Doppler echocardiography (RT3D-CDE) for quantifying shunt volume of irregular shaped and multiple VSDs.

Methods: Latex balloons were sutured into the ventricles of 32 freshly harvested porcine hearts and were connected with tubing placed in septal perforations. Tubing was varied in area (0.13-5.22 cm²), number (1-3), and shape (circle, oval, crescent, triangle). A pulsatile pump was used to pump "blood" through the VSD (LV to RV) at stroke volumes of 30-70 mL with a stroke rate of 60 bpm. Two-dimensional echocardiography (2DE), 3DE, and RT3D-CDE images were acquired from the right side of the phantom.

Results: For circular VSDs, both 2DE and 3DE area measurements were consistent with the actual areas (R² = 0.98 vs 0.99). For noncircular/multiple VSDs, 3DE correlated with the actual area more closely than 2DE (R² = 0.99 vs 0.44). Shunt volumes obtained using RT3D-CDE positively correlated with pumped stroke volumes (R² = 0.96).

Conclusions: Three-dimensional echocardiography (3DE) is a feasible method for determining VSD area and is more accurate than 2DE for evaluating the area of multiple or noncircular VSDs. Real-time 3D color Doppler echocardiography (RT3D-CDE) is a feasible method for quantifying the shunt volume of multiple or noncircular VSDs.

Keywords: color Doppler three-dimensional; echocardiography; perimembranous ventricular septal defect; shunt; three-dimensional echocardiography.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Disease Models, Animal
  • Echocardiography / methods*
  • Echocardiography, Doppler, Color / methods
  • Echocardiography, Three-Dimensional / methods
  • Feasibility Studies
  • Heart Septal Defects, Ventricular / diagnostic imaging*
  • Heart Septal Defects, Ventricular / pathology
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / pathology
  • In Vitro Techniques
  • Reproducibility of Results
  • Swine