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J Thorac Cardiovasc Surg 2004;128:53-59
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Three-dimensional echocardiography–guided atrial septectomy: An experimental study

^a Cardiac Surgery and Cardiology, Children's Hospital–Boston, Boston, Mass, USA
^b Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, USA
^c Division of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan

Received for publication January 23, 2004; revisions received March 8, 2004; accepted for publication March 11, 2004.

^* Address for reprints: Pedro J. del Nido, MD, Department of Cardiac Surgery, Children's Hospital–Boston, 300 Longwood Ave, Boston, MA 02115, USA
pedro.delnido{at}tch.harvard.edu

OBJECTIVES: The surgical feasibility of beating-heart atrial septectomy under the guidance of two different types of real-time 3-dimensional echocardiography systems was examined.

METHODS: A modified real-time 3-dimensional echocardiography system with a x4 matrix transducer (Sonos 7500; Philips Medical Systems, Andover, Mass) or a mechanical 1-dimensional array transducer (SSD-5500; Aloka Co, Ltd, Tokyo, Japan) was used. Small porcine atrial septal defects (n = 8) were enlarged with a Kerrison bone punch in the tank model. In the animal studies, small atrial septal defects (n = 8) were enlarged with the same device through a transatrial port. In both experiments, the area of the atrial septal defect measured by real-time 3-dimensional echocardiography was compared with the area measured directly.

RESULTS: Real-time 3-dimensional echocardiography provided satisfactory images and sufficient anatomic detail for the atrial septectomy in both experimental settings. All the atrial septal defects were successfully enlarged; an increase of as much as 293% of the preoperative atrial septal defect area was achieved in the tank experiment, and an increase of as great as 449% of the preoperative area was achieved in the animal experiment. The size of the atrial shunt was increased significantly after the atrial septectomy relative to that before the surgery (P < .0001). The percentage enlargement of the atrial septal defect measured by real-time 3-dimensional echocardiography was strongly correlated with that measured directly (both r² = 0.997, P < .0001) Bland-Altman analysis showed close agreement between the results obtained by the two measurement methods in both models.

CONCLUSIONS: Real-time 3-dimensional echocardiography provides satisfactory images and sufficient anatomic detail for atrial septectomy. This experiment demonstrates the surgical feasibility of a beating-heart intracardiac procedure such as atrial septectomy under real-time 3-dimensional echocardiographic guidance.

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