title: Correlations with operative anatomy of real time three-dimensional echocardiographic imaging of congenital aortic valvar stenosis.
abstract: OBJECTIVE
  To define the anatomic characteristics of the congenitally malformed and severely stenotic aortic valve using trans-thoracic real time three-dimensional echocardiography, and to compare and contrast this with the valvar morphology as seen at surgery.
  
  
  METHODS
  Prospective cross-sectional observational study.
  
  
  METHODS
  Tertiary centre for paediatric cardiology.
  
  
  METHODS
  All patients requiring aortic valvotomy between December 2003 and July 2004 were evaluated prior to surgery with three-dimensional echocardiography. Full volume loop images were acquired using the Phillips Sonos 7500 system. A single observer analysed the images using "Q lab 4.1" software. The details were then compared with operative findings.
  
  
  RESULTS
  We identified 8 consecutive patients, with a median age of 16 weeks, ranging from 1 day to 11 years, with median weight of 7.22 kilograms, ranging from 2.78 to 22 kilograms. The measured diameter of the valvar orifice, and the number of leaflets identified, corresponded closely with surgical assessment. The sites of fusion of the leaflets were correctly identified by the echocardiographic imaging in all cases. Fusion between the right and non-coronary leaflets was identified in half the patients. Dysplasia was observed in 3 patients, with 1 patient having nodules and 2 shown to have excrescences. At surgery, nodules were excised, and excrescences were trimmed. The dysplastic changes correlated well with operative findings, though statistically not significant.
  
  
  CONCLUSIONS
  We recommend trans-thoracic real time three-dimensional echocardiography for the assessment of the congenitally malformed aortic valve, particularly to identify sites of fusion between leaflets and to measure the orificial diameter. The definition of nodularity, and the prognosis of nodules based on the mode of intervention, will need a comparative study of patients submitted to balloon dilation as well as those undergoing surgical valvotomy.
authors.affiliation: Wessex Cardiothoracic Centre, Paediatric Cardiology, Southampton General Hospital, Southampton, United Kingdom.
authors.forename: Shankar N
authors.initials: SN
authors.lastname: Sadagopan
authors.forename: Gruschen R
authors.initials: GR
authors.lastname: Veldtman
authors.forename: Muthukumaran C
authors.initials: MC
authors.lastname: Sivaprakasam
authors.forename: Barry R
authors.initials: BR
authors.lastname: Keeton
authors.forename: James P
authors.initials: JP
authors.lastname: Gnanapragasam
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Salmon
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Haw
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Vettukattil
mesh_terms: D001024:Aortic Valve Stenosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome