Utility of 3-Dimensional Echocardiography in Patients With Complex Intracardiac Connections and Ventricular Septal Defects

The surgical management of patients with complex intracardiac connections, ventricular septal defect (VSD), and 2 adequately sized ventricles is challenging. Understanding the VSD anatomy and its spatial relationships with the outflow tracts is critical to determining the suitability for biventricular repair. Transthoracic 2-dimensional echocardiography (2D-echo) is the primary cardiac imaging tool in congenital heart disease. Transthoracic 3-dimensional echocardiography (3D-echo) has an additive role over 2D-echo in the definition of the potential baffle pathway from the VSD to the semilunar valves, the anatomical characteristics of the VSD, and any substrate for systemic outflow tract obstruction postrepair. In this paper, we describe 4 cases where transthoracic 3D-echo provided crucial delineation of the intracardiac connections and the VSD anatomy for surgical planning. We also describe our transthoracic 3D-echo protocol to evaluate these complex heart defects.