Atrial septal defect echocardiography modalities

Atrial Septal Defect Microchapters
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Ostium Secundum Atrial Septal Defect
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Claudia Hochberg, M.D.

Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Keri Shafer, M.D. [3]; Priyamvada Singh, MBBS [[4]]

Assistant Editor-In-Chief: Kristin Feeney, B.S. [[5]]

Overview

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.

Specific Echocardiography Techniques for ASD

In addition to determining the size and location of the defect, it is imperative to determine if other defects exist namely cleft mitral valve or anomalous pulmonary veins. As well 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 subcostal four-chamber view:
  • Key to determine which type of defect exists
  • Necessary to evaluate for anomoulous pulmonary veins
  • Evaluates for an atrial septal aneurysm
• Doppler:
  • 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
• Contrast echocardiography is often necessary to deterimine 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
• 3-D and Transesophageal echo (TEE) may be needed to adequately visualize the defect