C  2006, the Authors Journal compilation C  2006, Blackwell Publishing, Inc. RESEARCH FROM THE UNIVERSITY OF ALABAMA AT BIRMINGHAM Usefulness of Live/Real Time Three-Dimensional Transthoracic Echocardiography in the Characterization of Ventricular Septal Defects in Adults Farhat Mehmood, M.D., Andrew P. Miller, M.D., Navin C. Nanda, M.D., Vinod Patel, M.D., Anurag Singh, M.D., Kurt Duncan, M.D., Sanjay Rajdev, M.D., Sibel Enar, M.D., Vikram Singh, M.D., Anthony Nunez, M.D., ∗ David C. McGiffin, M.D., ∗ James K. Kirklin, M.D., ∗ and Albert D. Pacifico, M.D. ∗ Division of Cardiovascular Diseases, and ∗ Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama In this report, we present 12 patients (range 14–76 years, mean 40 ± 22.7 years) who underwent sur- gical repair of a ventricular septal defect (VSD). Location, size, and surrounding anatomy of the VSD were assessed prior to intervention in all patients with live/real time three-dimensional transthoracic echocardiography (3DTTE). In 9 patients, measurements of maximum dimension, circumference, and area by 3DTTE correlated well with the same measurements from intraoperative three-dimensional transesophageal echocardiographic (3DTEE) reconstruction. 3DTTE measurement of maximum di- mension of VSDs also agreed well with maximum dimension by surgery in 10 patients. Live/real time 3DTTE accurately defined VSD location, size, and surrounding anatomy in all patients stud- ied by us. VSD characterization by live 3DTTE agreed well with surgery descriptions and 3DTEE measurements. (ECHOCARDIOGRAPHY, Volume 23, May 2006) ventricular septal defect, three-dimensional echocardiography, ventricular septal rupture Important information for surgical planning of patients with ventricular septal defects (VSD) includes defect size, shape, location, and characterization of the surrounding anatomy. By two-dimensional transthoracic echocardio- graphy (2DTTE) and multiplane 2D trans- esophageal echocardiography (2DTEE), the di- agnosis of VSD can be made and one or two dimensions can be measured; however, one can- not be certain that the maximum dimension has been delineated. Also, since the defect is not visualized en face, its area or circumference cannot be measured. In addition, shape or com- plexity (swiss-cheese or multiple-hole types of defects) and the marginal rim of septal tissue Address for correspondence and reprint requests: Navin C. Nanda, M.D., University of Alabama at Birmingham, Heart Station SW/S102, 619 19th Street South, Birmingham, AL 35249. Fax: 205-934-6747; E-mail: nanda@uab.edu are not defined. With the increasing utilization of transcatheter closure of septal defects, it is es- sential that the anatomy of the defect and of the surrounding structures is better understood. 1–8 Three-dimensional (3D) imaging offers incre- mental value over 2D imaging by reproducing the “surgeon’s view” via creation of an en face view. 9,10 Multiplane 3D transesophageal echocardiog- raphy (3DTEE) has been validated and widely utilized prior to surgical intervention in order to facilitate accurate evaluation of VSDs. 11–13 3DTEE provides en face images of the ventric- ular septum and has been validated as a useful tool in characterizing size and shape of VSDs; however, it is also semi-invasive and requires more intensive sedation and monitoring of pa- tients. 11–13 A noninvasive technique that would permit en face imaging of the ventricular sep- tum for VSD sizing and for closure assessment Vol. 23, No. 5, 2006 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. 421