Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Assessment of Transposition of the Great Arteries in the Adult

Abstract

We studied 11 adult patients with dextro-transposition and 5 adult patients with levo-transposition (corrected transposition) of the great arteries with real time two-dimensional (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE). All patients with dextro-transposition underwent a Mustard or Senning procedure during infancy. Incremental findings provided by 3DTTE and not delineated by 2DTTE were (a) comprehensive examination of all three leaflets of the tricuspid valve including the detection and measurement of anatomic defects in the leaflets and the assessment of systolic noncoaptation and segmental prolapse; (b) en face viewing and measurement of vena contracta areas of the valvular regurgitation jets and the assessment of regurgitant volumes; (c) en face viewing of the intra-atrial baffle and localization and measurement of baffle defects as well as the measurement of vena contractas of the baffle leaks; (d) recognition of a bicuspid pulmonary valve; and (e) the quantitative assessment of left ventricular outflow tract obstruction. 3DTTE appears to be a useful noninvasive modality which could supplement 2DTTE in the comprehensive assessment of adult patients with transposition of the great arteries.

Three-Dimensional Echocardiography in Adult Congenital Heart Disease

“…For example, in transposition of the great arteries following atrial switch procedure, RT3DE facilitates evaluation of the intra-atrial baffles with localization of baffle obstruction, detection and delineation of baffle leaks, detection and quantitation of AV valve regurgitation, and assessment of outflow tract obstruction [27].…”

The Incremental Value of Three‐Dimensional Transthoracic Echocardiography in Adult Congenital Heart Disease

“…In patients with D‐TGA, the presence of a shunt between left and right circulations such as ASD, VSD, or persistent ductus arteriosus is essential for survival of the newborn and surgical repair is required early in life for survival into adulthood. Previously, atrial switch procedures (Senning or Mustard) were commonly performed by creating a baffle to move deoxygenated blood from the inferior and superior vena cavae to the left side of the heart . Unfortunately, the atrial switch surgeries are associated with several complications later in life including baffle leaks, obstructions, tricuspid valve insufficiency, arrhythmias, ventricular failure, and sudden death .…”

“…L‐TGA, also called congenitally corrected TGA, includes not only ventriculoarterial discordance but also atrioventricular discordance. With atrioventricular discordance, the right atrium connects to the left ventricle which connects to the pulmonary artery and the left atrium connects to the right ventricle which connects to the aorta . Although some patients with L‐TGA (especially those with other associated anomalies, e.g.…”

“…Three‐dimensional TTE can quantify the areas of systolic noncoaptation of the leaflets, evaluate specific defects in the valvular leaflets, and assess for the presence of prolapse of leaflet parts. Unlike 2D TTE, 3D TTE is able to monitor progression of the defect by visualizing and sizing the vena contracta and quantifying the severity of regurgitation . Other advantages of 3D TTE include its superior ability to visualize the pulmonic valve and left ventricular outflow tract from various detailed views, the identification of the exact location of outflow tract obstruction (can be present in as many as 33% of patients with TGA), and the systolic anterior motion of the mitral valve .…”

“…Unlike 2D TTE, 3D TTE is able to monitor progression of the defect by visualizing and sizing the vena contracta and quantifying the severity of regurgitation . Other advantages of 3D TTE include its superior ability to visualize the pulmonic valve and left ventricular outflow tract from various detailed views, the identification of the exact location of outflow tract obstruction (can be present in as many as 33% of patients with TGA), and the systolic anterior motion of the mitral valve . Three‐dimensional TTE is useful for patients who previously underwent atrial switch procedures to assess for long‐term complications including baffle leaks and obstruction which 2D TTE can miss .…”