title: 3D transthoracic echocardiography to assess pulmonary valve morphology and annulus size in patients with Tetralogy of Fallot.
abstract: BACKGROUND
  Accurate evaluation of the pulmonary valve (PV) is crucial before surgical repair of Tetralogy of Fallot (TOF).
  
  
  OBJECTIVE
  To assess PV and pulmonary annulus (PA) morphology using three-dimensional (3D) transthoracic echocardiography (TTE) in infants referred for surgical repair of TOF. Also, to compare PA measurements obtained by 3D TTE with those from other imaging modalities, including two-dimensional (2D) TTE and computed tomography (CT), with reference to surgical measurements.
  
  
  METHODS
  3D zoom mode was used to assess PV morphology. 2D TTE and CT PA diameters were compared to both vertical and horizontal diameters obtained from 3D datasets. Surgical PA diameters were measured using Hegar's dilators.
  
  
  RESULTS
  A total of 29 patients with TOF (median [range] age 6 [3-24] months) were included and all successfully underwent 2D and 3D TTE; 22 also underwent CT. The number of pulmonary leaflets could be visualized in 24 patients (82.8%), with complete concordance with surgical findings. Vertical diameter was significantly longer than horizontal diameter (P<0.001)-underlying PA eccentricity-and was more important in bicuspid than tricuspid valves. Correlations between 2D and 3D TTE diameters were good. Surgical diameter was better correlated with 2D and 3D diameters than with CT diameter. 3D minimum, 2D and CT diameters were significantly lower than surgical diameters, but 3D mean and maximum diameters were not.
  
  
  CONCLUSIONS
  3D TTE is accurate to assess PV morphology and PA size in patients with TOF. 2D TTE and CT underestimate PA diameter with reference to surgical diameter, however 3D mean and maximum diameters did not differ significantly.
authors: Pediatric Cardiology Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France. Electronic address: drhadeed@hotmail.fr.
authors: Khaled
authors: K
authors: Hadeed
authors: Pediatric Cardiology Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
authors: Sébastien
authors: S
authors: Hascoët
authors: Pediatric Cardiology Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
authors: Romain
authors: R
authors: Amadieu
authors: Pediatric Cardiology Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
authors: Yves
authors: Y
authors: Dulac
authors: Pediatric Cardiology Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
authors: Sophie
authors: S
authors: Breinig
authors: Pediatric Cardiac Surgery Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
authors: Alexandre
authors: A
authors: Cazavet
authors: Pediatric Cardiac Surgery Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
authors: Fabio
authors: F
authors: Cuttone
authors: Pediatric Cardiac Surgery Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
authors: Bertrand
authors: B
authors: Léobon
authors: Pediatric Cardiology Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.
authors: Philippe
authors: P
authors: Acar
mesh_terms: D002675:Child, Preschool; D019560:Echocardiography, Three-Dimensional; D006801:Humans; D007223:Infant; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011664:Pulmonary Valve / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000601:surgery; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: Anneau pulmonaire; Cardiac computed tomography; Pulmonary annulus; Pulmonary valve; Scanner cardiaque; Three-dimensional echocardiography; Two-dimensional echocardiography; Valve pulmonaire; Échocardiographie bidimensionnelle; Échocardiographie tridimensionnelle