Atrial septal defect echocardiography

Atrial Septal Defect Microchapters
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Ostium Secundum Atrial Septal Defect
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [[2]]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [[4]]

Overview

Echocardiography is the preferred diagnostic tool in the evaluation of an atrial septal defect. Out of the different types of echocardiographic modalities that can be used, trans-esophageal echocardiography can be used for all types of atrial septal defects. Other modalities like transthoracic echocardiography are used mostly for secundum type of atrial septal defects. As an evaluative tool, echocardiograms can: locate the defects, identify the direction of shunting, identify associated anomalies, evaluate atrial and ventricular enlargement. In general, an atrial septal defect patient will present symptomatic evidence of hemodynamic disruptions between the left and right atriums.* Atrial septal defects in adults could be best visualized by subcostal views with deep inspiration and high right parasternal views.

   * Ideally the entire atrial septum from the orifice of the superior vena cava to the orifice of the inferior vena cava should be visualized. This helps in detecting sinus venosus defects and large ostium secundum defects that might extends up-to that area.
   * It also helps in identifying pulmonary veins morphology that could be helpful in sinus type of atrial septal defects and assocaiated lesions.
   * In case of diagnostic dilemmas with adults with transthoracic echocardiography, TEE helps in exact localization, size of the ASD and measurement of septal rims. All these details also help in making surgical decisions.
   * The entire coronary sinus roof should be imaged to diagnose sinus atrial septal defect. A large coronary sinus orifice with evidence of atrial shunting may indicate a defect in the roof of the coronary sinus.
   * With pulmonary artery hypertension, the low velocity of the shunt flow across the coronary sinus defect may be difficult to distinguish from other low-velocity flow within the atria.

Indications

Echocardiography is the preferred diagnostic imaging method for the evaluation of many congenital heart diseases, including atrial septal defect. An echocardiogram allows for identification of the functional issues with the heart's anatomy. In suspected atrial septal defect patients, an echocardiogram can:

• Locate the defect
• Identify the direction of shunting
• Identify associated anomalies
• Evaluate atrial enlargement
• Evaluate ventricular enlargement

There are many types of echocardiography imaging beneficial for atrial septal defect diagnosis.

Advantages

Echocardiography can provide:

• Direct visualization of the defect in a subcostal 2-dimension view
• A visualization, when right ventricular volume overload is present, of:

• Pulmonary arterial dilatation
• Right ventricular dilatation
• Anterior systolic/paradoxic septal motion

• Imaging of an associated mitral valve prolapse.

• Transthoracic echocardiography (TTE) can be used for identification of ostium secundum defects.
• Transesophageal echocardiography (TEE) can aid in identification of:

• Size of defects
• Type of sinus venosus defect (SVC or IVC)
• Any associated anomalies/abnormalities

• Doppler flow echocardiography can identify:

• Shunt ratios
• Shunt volume
• Pulmonary artery pressure

If the individual has adequate echocardiographic windows, it is possible to use the echocardiogram to measure the cardiac output of the left ventricle and the right ventricle independently. In this way, it is possible to estimate the shunt fraction using echocardiography.

Doppler

Videos showing echocardiographic findings in specific defects:

Ostium primum defects|Ostium secundum|Patent foramen ovale|Sinus venosus