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{{Atrial septal defect}}
{{Atrial septal defect}}
{{CMG}}; Claudia Hochberg, M.D.
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com], {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]


'''Associate Editors-In-Chief:''' {{CZ}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; [[Priyamvada Singh|Priyamvada Singh, MBBS]] [[mailto:psingh@perfuse.org]]
'''For a full discussion on the usage of echocardiography for atrial septal defect diagnosis click [[atrial septal defect echocardiography|here]].'''


'''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [[mailto:kfeeney@perfuse.org]]
==Overview==
Echocardiography is the preferred diagnostic tool in the evaluation of an atrial septal defect. A range of techniques may be employed to definitively image and diagnose the nature of an atrial septal defect. These include modalities such as: M-mode, trans-thoracic, trans-esophageal, contrast, and Doppler.
 
==Echocardiography==
A range of echocardiography techniques can be used to visualize and diagnose a suspected atrial septal defect. Each technique offers additional imaging information to support an atrial septal defect diagnosis.
 
===M-mode===
* Effective modality for imaging moderate to large ostium secundum atrial septal defects
:* Provides imaging of:
::* Right ventricular enlargement
::* Paradoxical motion involving the interventricular septum
 
===Disadvantages===
* M-mode modality can appear indicative of [[right ventricular overload]]. It is not substantial enough alone to make a full diagnosis of a suspected atrial septal defect.


==Overview==
===[[Atrial septal defect transthoracic echocardiography|Trans-thoracic echocardiography (TTE)]]===
Echocardiography may be used as a diagnostic tool in the evaluation of an atrial septal defect. As an evaluative tool, echocardiograms can identify functionality issues within the heart's anatomy. The function of echocardiography in identifying atrial septal defect is to: located and number defects, identify direction of shunting, identify associated anomalies, evaluate atrial and ventricular enlargement. As such, specific techniques unique to identifying atrial septal defects may be employed to definitively determine the nature of the defect.
 
===[[Atrial septal defect transesophageal echocardiography|Trans-esophageal echocardiography (TEE)]]===


==Specific Echocardiography Techniques for ASD==
===[[Atrial septal defect contrast echocardiography|Contrast echocardiography]]===
In addition to determining the size and location of the defect through standard echocardiography techniques, it is imperative to determine if other defects exist namely cleft mitral valve or anomalous pulmonary veins.  Researchers have developed specific techniques for atrial septal defect identification. The purpose of each technique is to utilize dimensional imaging to identify various attributes of the atrial septal defect in terms of spacial and planar characteristics. Often, Doppler measurements are used to estimate the right pulmonary pressures as well as the direction of flow across the defect.


Other special techniques include the following.
===Doppler===
==='''The Subcostal Four-Chamber View'''===
* Used to demonstrate left to right flow.
**Key to determine which type of defect exists.
* Effective modality for:
**Necessary to evaluate for anomoulous pulmonary veins.
:* Confirmation of a suspected atrial septal defect
**Evaluates for an atrial septal aneurysm.
:* Estimation of the defect size
:* Determination of the universal direction of flow across the septum
:* Determination of the usage of percutaneous closure and surgical therapies
:* Determination of high velocity flow, useful in patients with restrictive defects, obstructed pulmonary venous return and/or left atrial hypertension


==='''Doppler'''===
====Disadvantages====
**Used to demonstrate left to right flow.
* May show false positive shunting as caval flow and incorrectly set gain may appear as left to right flow.
**May show false positive shunting as caval flow and incorrectly set gain may appear as left to right flow.
* Coloring across the interatrial septum can distort the perception of the shunt flow
* Not effective in determination of sinus venosus defects


==='''Contrast echocardiography'''===
===ACC / AHA 2008 Guidelines - Evaluation of the Unoperated Patient - Atrial Septal Defect (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677  }} </ref>===
**Often necessary employed to determine presence of intracardiac shunting done in the apical four chamber view. Drawbacks include difficulty in quantifying the size of the shunt as well as false positives in the setting of a pulmonary arteriovenous malformation.
**Agitated saline is commonly used as the contrast material.


===''''3-D/Transesophageal echocardiography (TEE)'''===
{| class="wikitable"
**Used for extensive dimensional imaging
|-
**Utilized to adequately visualize the defect in a multi-planar orientation.
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' ASD should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of RV volume overload and any associated anomalies. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}
[[CME Category::Cardiology]]


[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Congenital heart disease]]
[[Category:Congenital heart disease]]
[[Category:Pediatrics]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
{{WH}}
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Latest revision as of 01:50, 15 March 2016

Atrial Septal Defect Microchapters

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Patient Information

Overview

Anatomy

Classification

Ostium Secundum Atrial Septal Defect
Ostium Primum Atrial Septal Defect
Sinus Venosus Atrial Septal Defect
Coronary Sinus
Patent Foramen Ovale
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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]

For a full discussion on the usage of echocardiography for atrial septal defect diagnosis click here.

Overview

Echocardiography is the preferred diagnostic tool in the evaluation of an atrial septal defect. A range of techniques may be employed to definitively image and diagnose the nature of an atrial septal defect. These include modalities such as: M-mode, trans-thoracic, trans-esophageal, contrast, and Doppler.

Echocardiography

A range of echocardiography techniques can be used to visualize and diagnose a suspected atrial septal defect. Each technique offers additional imaging information to support an atrial septal defect diagnosis.

M-mode

  • Effective modality for imaging moderate to large ostium secundum atrial septal defects
  • Provides imaging of:
  • Right ventricular enlargement
  • Paradoxical motion involving the interventricular septum

Disadvantages

  • M-mode modality can appear indicative of right ventricular overload. It is not substantial enough alone to make a full diagnosis of a suspected atrial septal defect.

Trans-thoracic echocardiography (TTE)

Trans-esophageal echocardiography (TEE)

Contrast echocardiography

Doppler

  • Used to demonstrate left to right flow.
  • Effective modality for:
  • Confirmation of a suspected atrial septal defect
  • Estimation of the defect size
  • Determination of the universal direction of flow across the septum
  • Determination of the usage of percutaneous closure and surgical therapies
  • Determination of high velocity flow, useful in patients with restrictive defects, obstructed pulmonary venous return and/or left atrial hypertension

Disadvantages

  • May show false positive shunting as caval flow and incorrectly set gain may appear as left to right flow.
  • Coloring across the interatrial septum can distort the perception of the shunt flow
  • Not effective in determination of sinus venosus defects

ACC / AHA 2008 Guidelines - Evaluation of the Unoperated Patient - Atrial Septal Defect (DO NOT EDIT)[1]

Class I
"1. ASD should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of RV volume overload and any associated anomalies. (Level of Evidence: C) "

References

  1. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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