Non-invasive assessment of secundum atrial septal defect [ASD] versus patent foramen ovale by the use of transthoracic echocardiography [TTE] and 12 lead ECG in adults and adolescence. Efficacy of the procedure and results compared to transoesphageal echocardiography [TEE]

ABSTRACT

Transthoracic echocardiography represents a non-invasive technique for assessment of secundum atrial septal defect. However in some patients it is not always simple to identify the edges of the defect due to technical problems, obesity or echocardiographic experience. Transoephageal echocardiography represents the golden tool in assessment of secundum defects but may represent probable hazards of invasive procedures. Retrograde study in all patients who were diagnosed to have secundum ASD by TEE. All patients were subjected to TTE by different investigator and the results was calculated for sensitivity and specificity. The results were added to 12 lead ECG to assess the efficacy of 12 lead ECG to increased sensitivity and specificity of presence of secundum atrial defect than transthoracic echocardiography alone. All patients were adults and adolescence. Randomized study using 143 cases 96 females and 47 males with mean age 30 +/- 14 years youngest 14 years old and eldest 59 years old, referred to the National Heart Institute with suspected atrial septal defect by echocardiography. All patients were analyzed for clinical problems namely chest pain or dyspnoea and patients with atrial fibrillation were excluded from the study. Transthoracic echocardiography was used to prove the presence of secundum defect by apical 4 chamber, apical 2 chamber, parasternal and subcostal views, and blood flow by Doppler across the defect was analyzed and dimensions of the defect were calculated in millimeter together with the presence of tricuspid regurge +/- paradoxical septal wall motion abnormality. 12 lead ECG was used to prove the presence of right bundle block [RBBB] namely rsR, rSr or qRc. Right axis deviation and right ventricular strain are also detected. Transoephageal echocardiography was used in all patients to prove the secundum defect and analyze the results compared to transthoracic echocardiography and 12 lead ECG. The presence of right bundle block [RBBB] rsR was 48%, rSr 16%, and qRc 8%. All patients had incidence of RBBB in 62% of cases. Transthoracic echocardiography was used to prove the presence of secundum defect by apical 4 chamber, apical 2 chamber, parastemal and subcostal views were effective in only 24%, and blood flow by Doppler across the defect was not possible in all patients. The size of the defect were not calculated in all patients. Tricuspid regurge with different significant grades was present in 18% in of all patients and 75% in patients with secundum defect. Paradoxical septal wall motion abnormality was present in 9.1%. Transoephageal echocardiography was used in all patients, secundum defect were present in 42% of all patients and 100% of all patients with documented transthoracic data of secundum ASD +/- ECG of RBBB. The presence of secundum ASD is more common in females. Transthoracic echocardiography alone is not effective in giving proven data of secundum ASD except in 24% of patients. Combined use of 12 lead ECG of presence of RBBB and experienced non-invasive transthoracic echocardiography increase the possibility of proving the presence of secundum atrial septal defect with sensitivity of 85% and specificity 89%. Right axis deviation is detected in 52% and right ventricular strain in 15%, TEE remains the gold standard in proving the presence of secundum ASD with high sensitivity and specificity