Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Transoesophageal echocardiographic evaluation of atrial morphology in children with congenital heart disease
University Hospital Ronerdam, Sophia Children's Hospital, Thoraxcentre and Department of Pathology. Erasmus University, Rotterdam The Netherlands
Received 20 November 1990; revised 1 February 1991; .
Correspondence: Oliver Stümper, Department of Paediatnc Cardiology, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 ILF, U.K.
Abstract
In a prospective study, atrial morphology was evaluated by both transoesophageal and precordial echocardiography in 86 unoperated children with congenital heart disease (age range = 0.2 to 14.8 years, mean = 3.8 years) to determine what advantages, if any, might be inherent in the transoesophageal approach. The information derived from both ultrasound approaches was correlated and compared to information obtained during subsequent cardiac catheterization (78patients) and, or, surgical inspection (53 patients). A trial appendage morphology and hence atrial sit us was determined by transoesophageal echocardiography in every case (82 solitus, two right atrial isomerism, two left atrial isomerism). In addition, the transoesophageal approach indicated left juxtaposition in four patients, compared to only one by precordial examination. Probe patency of the foramen ovale was correctly predicted in 21 patients by transoesophageal imaging, but in only 10 by precordial imaging. In two children significant secundum defects, undetected by the precordial route, were identified. Multiple atrial septal defects were correctly defined infour patients by transoesophagealstudy but in only one by precordial study. Sinus venosus defects were documented in four by the transoesophageal approach, but in only one by the precordial. Primum defects were equally well documented (nine patients) by either technique, but the associated valve leaflet morphology was better documented by transoesophageal study in 5/9. A subtotal cor triatriatum was diagnosed in one child only by transoesophageal investigation.
Transoesophageal echocardiography allows a much more detailed evaluation of atrial morphology than precordial imaging even in infants. It provides direct diagnosis of atrial situs, detection ofjuxtaposed atrial appendages and improved demonstration or definitive exclusion of atrial septal defects.
Key Words: Echocardiography • heart disease • congenital • septal defects • atrial situs
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