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Aims Intracardiac echocardiography (ICE) and two-dimensional transoesophageal echocardiography (2D TEE) are used in most centres for guiding transcatheter atrial septal defect (ASD) closure. ASDs have complex shapes that are not well characterized with 2D imaging. Real-time 3D TEE (RT3D TEE) provides en-face visualization of the ASD, allowing precise assessment of ASD dimensions. Accordingly, our aims were (i) to determine the feasibility of RT3D TEE to guide ASD closure and (ii) to compare ASD and balloon dimensions (BDs) using RT3D TEE vs. ICE and 2D TEE. Methods and Results Thirteen patients with ostium secundum ASD underwent transcatheter ASD closure. 2D TEE, RT3D TEE, and ICE images were acquired sequentially. RT3D TEE was feasible in all patients. Comparing RT3D TEE and 2D imaging, the mean difference in long-axis dimension was .5 mm (P= NS for both), and −1.4 mm in short-axis (2D TEE, P P = 0.06). BD was greater with 3D TEE vs. ICE (.9 mm). Conclusion RT3D TEE can be used to guide transcatheter ASD closure with the advantages of lower cost than ICE, and ability to visualize en-face views of the ASD. ASD and BD as measured by RT3D TEE differ when compared with 2D imaging. [ABSTRACT FROM AUTHOR]

Aims Real-time three-dimensional echocardiography (RT3DE) has been used to quantify mitral valve (MV) annular size and leaflet tenting parameters in small numbers of patients with different pathologies. We sought to establish normal values for RT3DE mitral annular, tenting, and papillary muscle parameters over a wide age range and to study their age and body surface area (BSA) dependency. Methods and results Transthoracic wide-angled RT3DE images of the MV were acquired in 120 subjects (52 females, 68 males, age: 37 ± 20 years) with normal left ventricular (LV) function, no risk factors, and less than or equal to mild mitral regurgitation. Custom software (RealView®) was used to trace the MV annulus, leaflets, and the papillary apparatus in mid-systole in 18 sequential cut planes obtained from the 3D data sets. Mitral valve annular area and height as well as tenting parameters (maximum and mean tenting height and mid-systolic tenting volume) were obtained and correlated with age and BSA. Wide inter-subject variability was noted in all parameters. Despite this variability, parameters directly affected by LV size were found to be BSA-dependent: MV annular area showed highest correlation with BSA (r = 0.78), followed by inter-papillary distance (r = 0.58) and postero-medial (PM) and antero-lateral (AL) papillary muscle annular distance (r = 0.57 and r = 0.46, respectively). Age did not correlate with either annular or tenting parameters, but showed moderate negative correlation with inter-papillary muscle angle (r = −0.52) and mild negative correlation with inter-papillary distance (r = −0.32), both normalized by BSA. Conclusions Real-time three-dimensional echocardiography-derived MV annular, tenting, and papillary muscle parameters vary widely in normal subjects. When used clinically, normal values of parameters that are age- and/or BSA-dependent need to be adjusted accordingly. [ABSTRACT FROM AUTHOR]