Atrioventricular Valve Morphology and Dynamics in Congenital Heart Disease as Imaged with Real-time 3-Dimensional Matrix-array Echocardiography: Comparison with 2-Dimensional Imaging and Surgical Findings

Objective We sought to describe our initial experience with real-time 3-dimensional echocardiographic (RT3DE) imaging of atrioventricular valve (AVV) anomalies in pediatric patients to resolve a specific morphologic or dynamic detail, which, although suggested, could not be well resolved during the conventional 2-dimensional (2D)/Doppler examination. Methods In all, 41 patients (age range 1 day-24 years) with different AVV anomalies underwent RT3DE as part of their comprehensive echocardiographic assessment. Matrix-array transducers with a frequency range of 1 to 4 MHz were used. The first 27 patients were not consecutive, and the RT3DE findings interpreted by one examiner were compared directly with the 2D findings interpreted by a different examiner. In the following consecutive 14 patients, the RT3DE findings were compared with the surgical findings and with the interpretations of their corresponding 2D examinations by 3 examiners who were blinded to the findings of RT3DE for more objective comparison. Results RT3DE imaging was successful in resolving the raised question in all patients. The morphology of the valve leaflets and their chordal attachments, the mechanism and origin of regurgitation, and the geometry of the regurgitant volume were well delineated by RT3DE imaging. In the second group of patients, there was agreement between the morphologic details delineated by RT3DE (a total of 21 specific questions raised) and the surgical findings in those patients who had immediate surgery. On the other hand, RT3DE showed prominent AVV chordal attachments in the left ventricular outflow tract in one patient, which was not considered surgically relevant during the repair. Conclusions Although RT3DE is still in its initial phase, has some technical limitations, and does not change the basic diagnosis made by 2D imaging, echocardiographic examination using the matrix-array transducer is a useful adjunct in delineating specific morphologic and dynamic details of the AVV in congenital heart disease.