Journal of the American Society of Echocardiography
Clinical InvestigationCongenital Heart DiseaseAssessments of Right Ventricular Volume and Function Using Three-Dimensional Echocardiography in Older Children and Adults With Congenital Heart Disease: Comparison With Cardiac Magnetic Resonance Imaging
Section snippets
Study Design
We recruited 54 consecutive patients with CHD who were referred for cardiac MRI on the basis of clinical indications. Three-dimensional echocardiography was performed within 2 hours of MRI to minimize any change in hemodynamic status. Height and weight were measured, and demographic data, including age, cardiac lesions, and previous surgical procedures, were obtained from medical records. All patients were in sinus rhythm and had biventricular physiology. This study was approved by the relevant
Feasibility
A total of 54 patients (31 male; median age, 17 years; range, 9-75 years) were enrolled in the study. All patients had CHD: 24 (44%) had undergone repair of tetralogy of Fallot; 5 (9%) had the right ventricle as the systemic ventricle; 9 (17%) had other lesions with significant involvement of the right ventricle, including Ebstein's anomaly, atrial septal defects with pulmonary hypertension, double-chamber right ventricles, and pulmonary atresia with pulmonary homograft; and 16 (30%) had
Discussion
The measurement of RV volume and RVEF using two-dimension echocardiography is unreliable because the RV shape is not accommodated by simple geometric assumptions. Three-dimensional echocardiography may overcome these limitations.2, 18 Early technology for 3DE was cumbersome and time consuming for both acquisition and analysis,7, 8, 9, 10 preventing its routine use in a clinical setting. With the introduction of real-time 3DE, the acquisition of a full-volume data set is rapid and more suited as
Conclusion
Approximately half of the patients with CHD had adequate images for RV analysis. There was no difference between 3DE and MRI for RVEF estimation, but 3DE underestimated RV volume compared with MRI. This underestimation was greater in larger ventricles. The ABD algorithm minimally underestimated RVEF but offered a significant reduction in analysis time.
Acknowledgments
We are indebted to Megan Burrows, cardiac sonographer; Annette Rief, adult CHD nurse practitioner; Mathangi Shanthakumar, statistician; Agustin Okamura, MRI analyst; Congbin Wen, MRI analyst; Sandra Winsor; and Anna Lydon, MRI technician for their contribution and assistance in this project.
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This study was supported by Project Grant 1250 from the National Heart Foundation of New Zealand (Auckland, New Zealand).