Classification of the Site of Ventricular Septal Defect with 2-Dimensional Doppler Echocardiography

Shin, Yung Woo; Park, Hee Ju; Sung, Si Chan

Abstract

One hundred seven consecutive patients aged 3 years to 34 years with simple ventricular septal defect were prospectively investigated with 2-dimensional Doppler echocardiography to assess the echocardiographic criteriae in defining the anatomic site of the VSD. The anatomy was confirmed in all patients at operation. Two-dimensional Doppler echocardiography correctly categorized the site and extension of VSDs in 104 of 107(97%). All doubly committed subarterial VSDs were correctly diagnosed as an area of discontinuity beneath the pulmonary valve in the parasternal short-axis plane taken at the aortic root level. Forty eight of 49 perimembranous VSDs with infundibular extension showed an area of discontinuity beneath the right aortic cusp in the parasternal long axis plane of the left ventricle. Of 17 perimembranous VSDs with trabecular extension, 16 had an area of discontinuity around the medial papillary muscle in the short axis plane taken at the level of high left ventricular outflow tract(LVOT). All 5 perimembranous VSDs with inlet extension showed an area of discontinuity adjacent to the septal leaflet attachment in the short axis plane taken at the level of high LVOT. One muscular trabecular VSD was categorized correctly by the short axis view and the apical 4-chamber view. Thus, these 2-dimensional Doppler echocardiographic criteriae are a simple and reliable in identifying the anatomic site of VSDs.