The present study evaluated the application of three dimensional echocardigraphy (3DE) in the diagnosis of atrial septal defect (ASD) and the measurement of its size by 3DE and compared the size with surgical findings. Two-dimensional and real-time three dimensional echocardiography (RT3DE) was performed in 26 patients with atrial septal defect, and the echocardiographic data were compared with the surgical findings. Significant correlation was found between defect diameter by RT3DE and that measured during surgery (r=0.77, P<0.001). The defect area changed significantly during cardiac cycle. Percentage change in defect size during cardiac cycle ranged from 6%-70%. Our study showed that the size and morphology of atrial septal defect obtained with RT3DE correlate well with surgical findings. Therefore, RT3DE is a feasible and accurate non-invasive imaging tool for assessment of atrial septal size and dynamic changes.
Echocardiography, Three-Dimensional ; Heart Septal Defects, Atrial/*diagnosis ; Heart Septal Defects, Atrial/*pathology ; Heart Septal Defects, Atrial/surgery ; Young Adult

Device based closure of the left atrial appendage (LAA) has emerged as a viable approach for stroke prevention in atrial fibrillation (AF) patients with contraindications to chronic oral anticoagulation. One of the most feared complications is device related thrombus formation. We present a 66-year-old male with chronic AF who developed a life-threatening intracranial bleed on oral anti-coagulation. He subsequently underwent LAA closure using an Amplatzer muscular ventricular septal defect closure device for stroke prevention. However, he was found to have a large thrombus attached to the device a year later. We present a review of the various LAA closure devices, importance of periodic surveillance via echocardiography and management options to prevent this complication. Also, the case highlights the importance of contrast-enhance echocardiography in diagnosis of LAA closure device thrombus.
Aged ; Atrial Appendage ; Atrial Fibrillation ; Diagnosis ; Echocardiography ; Heart Septal Defects, Ventricular ; Heart* ; Humans ; Male ; Stroke ; Thrombosis

The diagnosis of atrial septal defect by transthoracic echocardiography remains difficult in a small subset of patients because of either suboptimal acoustic windows or unusual anatomy, for example, fenestrated defects. wer report the case of a 52-year-old woman with a fenestratdd atrial septal aneurysm that was incompletely visualized by transthoracic echocardiography. Subsequent transesophageal echocardiography demonstrated atrial septal defect and two fenestrations within the atrial septal aneurysm with left-to-right shunting. All echocardiographic findings were confirmed at surgery. This case demonstrates the addinional diagnostic accuracy of transesophageal echocardiography for detecting disease of the atrial septum.
Acoustics ; Aneurysm* ; Atrial Septum ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Septal Defects, Atrial* ; Humans ; Middle Aged

The persistent left superior vena cava (LSVC) is not rare cardiovascular developmental anomaly occurring both in association with congenital heart disease and as an isolated anomaly of no hemodynamic importance. We have studied 73 cases of the LSCV out of 1,060 cases of congenital heart disease catheterized at Yonsei Cardiovascular Center. We conducted the study with a view point of position of the heart and abdominal organs and segmental analysis of the underlying congenital heart disease. We also analysed the associated extracardiac vascular anomalies. The following results were obtained: 1) The incidence of this anomaly among congenital heart disease was 6.9% and 41 cases(56.2%) had cyanosis. 2) We observed 20 cases(27.3%) with the malposition of the heart and 17 cases(23.3%) with malposition of the abdominal organs. The ventricular loops revealed D-loop in 60 cases, L-loop in 7 cases and in the remaining 6 cases, it was uncertain. 3) With a view point of type of LSVC by Lucas & Krabill, type A was in 50 cases(68.5%), type D in 14 cases(19.2%), type B in 5 cases(6.8%) and type C in 4 cases(5.5%). 4) Associated cardiovascular anomalies were as follows: ventricular septal defect; 42 cases(57.5%), atrial septal defect; 33 cases(45.2%), patent ductus arteriosus; 27 cases(36.9%), and tetralogy of Fallot; 18 cases(24.7%). In conclusion, LSVC usually has no hemodynamic importance, but this cardiac anomaly is frequently combined with complex intracardiac anomalies. Therefore, it is important to making accurate diagnosis and successful management for preventing the risk of it.
Catheters ; Classification* ; Cyanosis ; Diagnosis ; Ductus Arteriosus, Patent ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hemodynamics ; Incidence ; Tetralogy of Fallot ; Vena Cava, Superior*

PURPOSE: The purpose of our investigation was to explore the natural course, and the factors that influence the natural course, in ostium secundum atrial septal defect(ASD) diagnosed within the first 4 weeks of life. METHODS: We studied patients with ASD diagnosed within the first 4 weeks of life during the period from September 1995 to September 1999 in our hospital. The diagnosis and measuring of the size of ASD was carried out by two-dimensional echocardiogram(2DE, Hewlett-Packard Sonos 2500 ) from subcostal long and short axis views. RESULTS:There were 61 patients - 29 males and 32 females. According to the size of their defects, we divided them into four groups; group A(less than 4 mm : 24 cases), group B(four mm- six mm : 27 cases), group C(six mm-eight mm : six cases), group D(more than eight mm : four cases). In groups A and B, 22 of 24 patients(91.7%) and 23 of 27 patients(85.2%) had each closed spontaneously. In group C, four of six patients had closed spontaneously. In group D, no patient had closed spontaneously and three of four patients had been closed surgically. There were significant differences in the rate of spontaneous closure between less than six mm group and more than six mm group in the size of the defect(P<0.05). There were no significant differences in the rate of spontaneous closure between ASD combined with simple cardiac defect and isolated secundum ASD. CONCLUSION: We conclude that defects smaller than six mm in diameter are very likely to close spontaneously.
Axis, Cervical Vertebra ; Diagnosis ; Female ; Heart Septal Defects, Atrial* ; Humans ; Male

Umbilical vein varix has diverse clinical features and an unpredictable course during the pregnancy and/or perinatal period. We report a rare case of isolated fetal varix of the intra-abdominal umbilical vein, which was associated with fetal cardiomegaly. After birth, the umbilical vein varix remained with continuous blood flow through the patent ductus venosus. In addition, persistent cardiomegaly was complicated with an atrial septal defect.
Cardiomegaly ; Heart Septal Defects, Atrial* ; Parturition ; Pregnancy ; Prenatal Diagnosis ; Umbilical Veins* ; Varicose Veins*

Dextrocardia ; diagnosis ; Female ; Heart Septal Defects, Atrial ; diagnosis ; Heart Ventricles ; abnormalities ; Humans ; Infant, Newborn ; Truncus Arteriosus, Persistent ; diagnosis

For the determination of the usefulness of the pulsed Doppler echocardiographic diagnosis of ASD. We evaluated 185 children with congenital heart disase by subxiphoid approach. ASD was diagnosed when abnormal flow was recorded in right atrium. ASD was proved by surgery in 33 of 185 children with congenital heart disease, and all children had sugical correction of their heart deformities. On pulsed Doppler echocardiographic exmination, abnormal flow was recorded in 32 of the 33 children with ASD and 3 of 152 children without ASD. This pulsed Doppler echocardiographic diagnosis of ASD by abnormal flow in right atrium has sensitively of 97% and specificity of 98%. High correlation was found between the estimates of Qp/Qs ratio by Doppler and Fick method(r=0.90, P<0.01). So we concluded that pulsed Doppler echocardiographic diagnosis of ASD was specific and sensitive method and careful pulsed Doppler echocardiographic examination may avoid the unnecessary cardiac catheterizetion in patients with ASD.
Child ; Congenital Abnormalities ; Diagnosis ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Heart ; Heart Atria ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Sensitivity and Specificity

PURPOSE: The aims of this study was to assess the indication, diagnostic, accuracy and prognostic influence of fetal echocardiography. METHODS: From 1995 to 1999, 283 pregnancies were evaluated with fetal echocardiography at Dong-A University Hospital. We reviewed medical records included indication, fetal echocardiographic findings, postnatal echocardiographic findings, methods of treatment and outcome of prenataly diagnosed patients. RESULTS: Family history of congenital heart disease led to 32.2% of all fetal echocardiography with a detection rate of 2.1%. The most important indication of fetal echocardiography was suspected heart anomaly on a screening obstetric ultrasonography yield(detection rate : 61.7%). Nearly all forms of congenital heart disease were detected in utero. However several forms of structural congenital heart disease such as ventricular septal defect and anomalous pulmonary venous return were difficult to diagnosis in utero. In 13 fetuses arrhythmias were detected; the most common arrhythmia was premature atrial contraction. Improving the outcomes of patients with prenatal diagnosis are so far controversial because of the small number of cases and increased termination rates of fetuses with congenital heart disease. CONCLUSION: Fetal echocardiography has emerged as a reliable tool for prenatal detection of congenital heart disease and arrhythmia. But the effect of prenatally detected congenital heart disease on the management and the outcome of pregnancy can be controversial and legal problems may be important issues in the future.
Arrhythmias, Cardiac ; Atrial Premature Complexes ; Diagnosis ; Echocardiography* ; Fetus ; Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Humans ; Mass Screening ; Medical Records ; Pregnancy ; Prenatal Diagnosis ; Scimitar Syndrome ; Ultrasonography

This study was done to investigate the effect volume overloading of right ventricle(RV) on the left ventricular(LV) volume and function in patients with isolated secundum type atrial septal defect(ASD) and to determine the hemodynamic indices affecting the postoperative reduction of RV size. Pre and postoperative echocardiogram and equilibrium radionuclide cardiac angiogram were analyzed in 39 patients of isolated secundum type ASD, who had their diagnosis confirmed by right heart catheterization and were operated at Seoul National University Hospital from January 1982 to July 1984. The ratio fo RV end-diastolic dimension to LV end-diastolic dimension(RVED/LVED), ratio of LV pre-ejection period and LV ejection time(PEP/LVET), ejection fraction(E.F.), fractional shortening(F.S.) mean velocity of circumferential fiber shortening(mVcf), peak ejection rate(PER) and peak filling rate(PFR) were measured in 24 normal control subjects and 39 patients with ASD before and after operation. The results obtained were as follows : 1) The postop. reduction of RV size could be correlated with age at operation, but showed no correlation with the degree of QP/Qs, main pulmonary arterial systolic, diastolic, mean pressure, RVEDP and previous RV size. 2) The ratio of postop. RVED/LVED(0.58+/-0.15) was significantly decreased, compared with the ratio of preop(0.96+/-0.28)(P<0.005)(Mean+/-1 S.D.). In preop and postop. status of ASD, the ratio of RVED/LVED was significantly larger than that of normal control subject(0.30+/-0.09)(P<0.005). 3) The ratio of preop PEP/LVET(0.33+/-0.02) was significantly decreased, compared with ratio of preop PEP/LVET(0.39+/-0.04)(P<0.005). There was significant difference between the ratio of preop. PEP/LVET and ratio of normal control subjects(0.33+/-0.05)(P<0.005), but no significant difference between the ratio of postop. PEP/LVET and ratio of normal control subjects(P>0.1). 4) There was no significant difference in LV systolic contractile functional indices between ASD group and normal control subjects and between pre and postop. status of ASD patients : LVEF was 63.5+/-6.1(%) in preop., 63.0+/-5.7(%) in postop and 62.4+/-6.6(%) in normal control subjects. F.S. was 27.3+/-5.7(%) in preop., 28.2+/-3.1(%) in postop. and 28.7+/-4.5(%) in normal control subjects. mVcf was 0.81+/-0.11(Cire/sec) in preop., 0.80+/-0.10(Circ/sec) in postop. and 0.82+/-0.14(Circ/sec) in normal control subjects. PER was 2.82+/-0.61(EDV/sec) in preop., 2.84+/-0.56(EDV/sec) in postop. and 2.84+/-0.45(EDV/sec) in normal control subjects. 5) The postop. PFR 3.34+/-0.46(EDV/sec) was significantly increased, compared with preop. PFR 2.51+/-0.46(EDV/sec)(P<0.005). There was significant difference between preop. PFR and normal control PFR 3.29+/-0.66(EDV/sec)(P<0.005), but no significant difference between postop. PFR and normal control PFR(P>0.1). 6) The postop. RVEF(51.4+/-6.3%) was significantly decreased, compared with preop. RVEF(54.5+/-9.9%)(P<0.005). Pre and postop. RVEF of ASD patient were significantly lower than RVEF of normal control group(60.3+/-3.1%)(P<0.01, P<0.005). The results indicate that postop. reduction of RV size could be correlated with age at operation. The effect of RV volume overloading on LV could not change systolic contractile functional indices, but diastolic filling index. There is many evidences suggesting that RV filling influences LV diastolic function which are occured by means of left ward shift of the interventricular septum and indirectly by linkage of filling of the two ventricules by common enclosure in the pericardium(underfilled LV volume and decreased LV compliance). Mildly diminished overall LV performance as shown by systolic time intervals appears to be related to the volume overload of the RV and to the concomitantly diminished volume of LV rather than to any myocardial contractility. LV systolic time inverval was non-invasive and sensitive index in assessing overall LV performance independent to LV geometric configuration and abnormal motion of regional ventricular wall.
Cardiac Catheterization ; Cardiac Catheters ; Diagnosis ; Heart Septal Defects, Atrial* ; Heart Ventricles* ; Hemodynamics* ; Humans ; Seoul ; Systole ; Ventricular Function, Left*