Three-dimensional echocardiography-guided atrial septectomy: an experimental study.
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.
Suematsu
Yoshihiro
Y
Department of Cardiac Surgery, Children's Hospital-Boston, MA 02115, USA.
Marx
Gerald R
GR
Triedman
John K
JK
Mihaljevic
Tomislav
T
Mora
Bassem N
BN
Takamoto
Shinichi
S
del Nido
Pedro J
PJ
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