Real-Time 3-Dimensional Transesophageal Echocardiography Imaging
Adult Patent Ductus Arteriosus Before and After Transcatheter Closure
Novel matrix-array technology has been implemented in transesophageal probes recently, allowing real-time 3-dimensional (3D) transesophageal echocardiographic (TEE) imaging. This TEE transducer has been demonstrated to provide superb 3D visualization of posterior cardiovascular structures (eg, mitral valve, interatrial septum, and left atrial appendage); however, data about its usefulness in imaging of patent ductus arteriosus (PDA) are lacking.
A 71-year-old woman was admitted to the hospital for pulmonary edema. She had a history of arterial hypertension and exertional dyspnea (New York Heart Association class II to III) for ≈2 years. A conventional 2-dimensional transthoracic echocardiogram demonstrated left ventricular volume overload, moderate secondary mitral regurgitation, and severe pulmonary hypertension (mean pulmonary artery pressure of 45 mm Hg). Color Doppler flow mapping in the pulmonary trunk revealed continuous flow in the pulmonary trunk, which suggested the presence of a PDA. A large, window-like type of ductus was visualized on the TEE (Figure 1; online-only Data Supplement Movie I). Subsequently, the patient underwent elective transcatheter occlusion by a 10-mm Amplatzer muscular VSD (ventricular septal defect) occluder (AGA Medical Corp, Golden Valley, Minn). A control aortic angiogram showed a small residual shunt through the mesh of the occluder. Mean pulmonary artery pressure decreased significantly (mean pulmonary artery pressure of 30 mm Hg).
Both 2-dimensional and real-time 3D TEE were performed with a novel matrix-array transducer (X7-2t) and iE33 ultrasound machine (Philips Medical Systems, Andover, Mass). The patient was studied before and after transcatheter closure and at 6-month follow-up.
Real-time 3D TEE provided a novel view into the aorta at the level of the isthmus. Aortic entry of the PDA was visualized before treatment (Figures 2 and 3⇓; online-only Data Supplement Movies II and III) and after transcatheter PDA closure by the device (Figures 4 and 5⇓; online-only Data Supplement Movies IV and V). Figures 4 and 5⇓ demonstrate the optimal position of the Amplatzer muscular VSD occluder without any residual shunt. This early experience documents the usefulness of real-time 3D TEE in 3D imaging of PDA, although the cranial part of the aortic arch is invisible because of the near field.
The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/120/12/e92/DC1.