title: Three-dimensional echocardiography-guided atrial septectomy: an experimental study.
abstract: OBJECTIVE
  The surgical feasibility of beating-heart atrial septectomy under the guidance of two different types of real-time 3-dimensional echocardiography systems was examined.
  
  
  METHODS
  A modified real-time 3-dimensional echocardiography system with a x4 matrix transducer (Sonos 7500; Philips Medical Systems, Andover, Mass) or a mechanical 1-dimensional array transducer (SSD-5500; Aloka Co, Ltd, Tokyo, Japan) was used. Small porcine atrial septal defects (n = 8) were enlarged with a Kerrison bone punch in the tank model. In the animal studies, small atrial septal defects (n = 8) were enlarged with the same device through a transatrial port. In both experiments, the area of the atrial septal defect measured by real-time 3-dimensional echocardiography was compared with the area measured directly.
  
  
  RESULTS
  Real-time 3-dimensional echocardiography provided satisfactory images and sufficient anatomic detail for the atrial septectomy in both experimental settings. All the atrial septal defects were successfully enlarged; an increase of as much as 293% of the preoperative atrial septal defect area was achieved in the tank experiment, and an increase of as great as 449% of the preoperative area was achieved in the animal experiment. The size of the atrial shunt was increased significantly after the atrial septectomy relative to that before the surgery (P <.0001). The percentage enlargement of the atrial septal defect measured by real-time 3-dimensional echocardiography was strongly correlated with that measured directly (both r(2) = 0.997, P <.0001) Bland-Altman analysis showed close agreement between the results obtained by the two measurement methods in both models.
  
  
  CONCLUSIONS
  Real-time 3-dimensional echocardiography provides satisfactory images and sufficient anatomic detail for atrial septectomy. This experiment demonstrates the surgical feasibility of a beating-heart intracardiac procedure such as atrial septectomy under real-time 3-dimensional echocardiographic guidance.
authors.affiliation: Department of Cardiac Surgery, Children's Hospital-Boston, MA 02115, USA.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Suematsu
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Marx
authors.forename: John K
authors.initials: JK
authors.lastname: Triedman
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: Bassem N
authors.initials: BN
authors.lastname: Mora
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
mesh_terms: D000818:Animals; D006348:Cardiac Surgical Procedures; D003199:Computer Systems; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004195:Disease Models, Animal; D004285:Dogs; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D004867:Equipment Design; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000601:surgery; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008955:Models, Cardiovascular; D013552:Swine; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery