Live Three-dimensional Echocardiography Research Articles

GW26-e0229 Sinus of Valsalva aneurysm extending into left ventricle: combined diagnosis of conventional and live three-dimensional echocardiography

GW26-e0229 Sinus of Valsalva aneurysm extending into left ventricle: combined diagnosis of conventional and live three-dimensional echocardiography

GW25-e1545 A study on myocardial shear strain by stress and live three-dimensional echocardiography

GW25-e1545 A study on myocardial shear strain by stress and live three-dimensional echocardiography

The Value of Live Three‐Dimensional Echocardiography in an Adult Patient with Aortico‐Left Ventricular Tunnel

Aortico-left ventricular tunnel (ALVT) is a rare cardiac abnormality. This article presents an adult case of ALVT with aortic ostium lying above the left-noncommissure which was diagnosed with live three-dimensional echocardiography (3DE). Live 3DE has shown its value in providing more detailed information.

Diagnosis of unicommissural unicuspid aortic valve stenosis by different imaging modalities

A 32-year-old woman was admitted to our institution for further evaluation of aortic stenosis. Diagnosis of severe aortic stenosis was made by transthoracic echocardiography. Transesophageal echocardiography, live three-dimensional echocardiography and cardiovascular MRI allowed precise evaluation of valve morphology. Interestingly, valve morphology was unicuspid unicommissural with a posterior funnel-shaped valve opening. Surgical inspection during valve replacement confirmed the diagnosis of an unicuspid aortic valve. This case report highlights the use of different imaging modalities in characterizing aortic valve morphology.

Transoesophageal echocardiography after several transient ischaemic attacks

MOTS CLES Echocardiographie transœsophagienne ; A 75-year-old man underwent transoesophageal echocardiography after having several transient ischaemic attacks. Cardiac examination was unremarkable. The transverse view of the descending thoracic aorta by conventional two-dimensional transoesophageal echocardiography (Fig. 1, left panel) exhibited extensive atherosclerosis. Atherosclerotic plaques and debris are common findings in elderly patients. The aorta was analysed using live three-dimensional transoesophageal echocardiography (Fig. 1, right panel). This view demonstrates the extent and irregular shape of the atheromatous plaque. The presence of aortic debris may explain spontaneous embolization or embolization through diagnostic procedures, such as coronary angiography.

Incremental Diagnostic Value of Live Three-dimensional Transoesophageal Echocardiography in the Assessment of Mitral Regurgitation and Correlation with Operative Findings

Incremental Diagnostic Value of Live Three-dimensional Transoesophageal Echocardiography in the Assessment of Mitral Regurgitation and Correlation with Operative Findings

OP33.06: Live three-dimensional fetal echocardiography: a preliminary experience

OP33.06: Live three-dimensional fetal echocardiography: a preliminary experience

Live three-dimensional echocardiography of cor triatriatum in a child

Cor triatriatum sinistrum is a very rare condition constituting 0.1–0.4% of congenital heart disease. Patients most commonly present with breathlessness, and may be falsely diagnosed with asthma. Pulmonary hypertension may...

Assessment of Papillary Fibroelastomas with Live Three‐Dimensional Transthoracic Echocardiography

Seven consecutive patients presenting with typical echocardiographic features of papillary fibroelastoma requiring surgery were studied. All patients underwent standard two-dimensional (2D) transthoracic echocardiography (TTE) followed by live three-dimensional (live 3D) echocardiography with data set storage allowing analysis with systematic cropping of the acquired 3D data and volume measurement of the lesions. Assessment of papillary fibroelastoma by 2D and live 3D TTE was compared to operative findings. The feasibility of live 3D echocardiography in this setting was 100%. The quality of images was considered as optimal in three patients, good in three patients, and poor in one patient. A typical speckled appearance of the tumor was observed in three patients presenting with large tumors. The location of the tumor attachment was precisely defined in all but one patient, with a clear improvement in spatial assessment with live 3D TTE in three patients. Live 3D TTE also improved the operative planning in three patients. Live 3D TTE appears to be useful in the assessment of intracardiac tumors as small as papillary fibroelastomas, leading to a comprehensive approach of the lesion and facilitating the operative planning.

Assessment of atrial septum morphology by live three-dimensional echocardiography

To evaluate the morphology of atrial septum by the live three-dimensional echocardiography (L3DE) and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial septum. The study examined 49 patients with atrial septal defect (ASD), including 3 patients with atrial septal aneurysm, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneurysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%, ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with intraoperative findings (r=0.90). It is concluded that L3DE can clearly display the overall morphological features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.

Assessment of mitral prosthetic valve thrombosis by live three-dimensional echocardiography: comparison with transesophageal echocardiography

We report the feasibility of transthoracic live three-dimensional echocardiography in the diagnosis of a thrombus attached to the mitral bioprosthetic valve.

Usefulness of live 3D echocardiography during radiofrequency ablation in a case of hepatocellular carcinoma

We report a case of hepatocellular carcinoma (HCC) with chronic hepatitis C virus (HCV) infection, which was successfully treated with percutaneous radiofrequency ablation (RFA) under live three-dimensional (3D) echocardiography guidance. Recently, it was reported that live 3D echocardiography was able to enhance the efficacy of catheter-based endomyocardial injection since the 3D images made it possible to observe the target from multiple directions so that it guided more accurately. A 63-year-old Japanese man had an HCC nodule of 3.0 cm in diameter at the S8 region of the liver. Here we applied live 3D echocardiography during RFA therapy with a LeVeen needle electrode. The echocardiography guidance allowed for easier and accurate approach for needle puncture. The guidance was also effective to confirm whether an enough safety margin for the nodule was obtained. Thus, live 3D echocardiography appears to safely guide RFA needles by accurate targeting for HCC nodule, providing real-time visualization when combined with echocardiography contrast.

Feasibility and Clinical Impact of Live Three‐Dimensional Echocardiography in the Management of Congenital Heart Disease

Precise assessment of congenital heart lesions requires inferential evaluation from multiple two-dimensional echocardiographic images (2DE). The aim of our study was to assess the usefulness of transthoracic live three-dimensional echocardiography (3DE) in the evaluation of congenital heart disease. Eighty-two patients (from 4 months to 31 years, mean age 12 +/- 7.5, 38 males and 44 females), known to have congenital heart lesions, prospectively underwent both 2DE and 3DE. Conventional data acquisition by 2DE and "full volume" 3DE acquisition (apical four chambers, parasternal long and short axes, subcostal windows) were carried out by two independent and blinded operators. Data derived from 3DE were compared to 2DE, and 3DE results were graded into three categories: (A) new findings not seen on 2D echo studies, but not critical to therapeutic decision making; (B) additional anatomic information useful in therapeutic decision making; and (C) information equivalent to 2D echo studies. Two out of 82 patients (2%) were excluded because of suboptimal 3DE images. In comparison with 2DE studies, 3DE was graded A in 23 patients (29%), B in 28 patients (35%), and C in 29 patients (36%). In the patients with group B results, atrial and ventricular septal defects, endocardial cushion defects, and l-transposition of great vessels were the most represented pathologies in which 3DE aided medical or surgical therapeutic options. While the new findings in group A did not influence therapy, they defined the whole spectrum of abnormalities in those patients. In patients who fell under group C results, 3DE provided a direct realistic display of the pathology detected by 2DE. Our study demonstrates that live 3DE, easily performed at the bedside, provides incremental information on patients with a variety of congenital heart lesions. In the clinical scenario, it clarifies the pathology in all its dimensions, particularly in complex lesions with the incremental information having impact on therapeutic decision making.

2152: Clinical study on the evaluation of prosthetic valve with live three-dimensional echocardiography

Objectives: To evaluate the possibility and the accuracy of live three-dimensional echocardiography (live 3DE) on the assessment of the functional states and the hemodynamic changes of prosthetic valve.

Assessment of Left Atrial Appendage by Live Three‐Dimensional Echocardiography: Early Experience and Comparison with Transesophageal Echocardiography

Live Three-Dimensional Echocardiography (L3D, Sonos 7500, Philips) has the potential to visualize all cardiac structures including left atrial appendage (LAA). We tested the feasibility of evaluating LAA by L3D and compared the findings to transthoracic echocardiography (2D) and in a subset of patients with transesophageal echocardiography (TEE). L3D images were obtained in 204 consecutive patients referred for routine 2D or TEE. We performed wide-angled acquisitions from parasternal and apical views. TomTec system (4D Cardio-view, RT 1.2) was used to visualize LAA from multiple vantage points. LAA was adequately visualized by L3D in 139 of 204 (68.1%) patients. L3D visualization was dependent on image quality, suboptimal in 100 and diagnostic in 104 patients. Overall, LAA was visualized in 93 (45.5%) patients by 2D compared to 139 (68.1%) by L3D (P < 0.0001). In 100 patients with suboptimal image quality by L3D, LAA visualization was 16% by 2D and 35% by L3D, whereas in 104 patients with diagnostic images, LAA was visualized in 77 (74%) by 2D and in all 104 (100%) patients by L3D (P < 0.0001). In 37 patients referred for transesophageal echocardiography (TEE), live three-dimensional echocardiography (L3D) visualized left atrial appendage (LAA) in 34 patients with diagnostic image quality. Eight patients with LAA thrombi on TEE had thrombi detected by L3D as well. All patients with LAA thrombus had enlarged LA by both 2D and TEE. L3D is a promising technique in evaluation of LAA with and without thrombi. In patients with good quality transthoracic images L3D may be used as a screening tool in assessment of LAA.

Observation of Mitral Apparatus Change in Acute Ischemic Mitral Regurgitation by Live Three-Dimensional Echocardiography

Objective. Mitral apparatus geometry changes during ischemic mitral regurgitation (MR) play an important role in finding mechanisms for ischemic MR. Live three-dimensional echocardiography (L3DE) is a new technique providing cardiac full-volume image in a very short time. We applied this technique to evaluate mitral apparatus geometry changes during acute ischemic MRs.Methods. After baseline two-dimensional echocardiography (2DE) and L3DE image acquiring, the left circumflex (LCX) coronary artery distal to the first obtuse marginal artery origin was ligated in order to produce an acute ischemic MR in 10 canines. When significant ischemic MR occurred, 2DE and L3DE imagings were repeated. PM tethering distance and mitral annular geometric dilation were measured by L3DE.Results. Acute ischemic MR was successfully produced by LCX ligation in 8 canines. MR grade increased from 0.5±0.2 at baseline to 2.4±0.2 during ischemic MR in scale, P2=0.77).Conclusions. Live three-dimensional echocardiography can show mitral annulus spatial configuration and can be used to address questions related to mitral apparatus. Mitral apparatus geometry changes are contributed to acute ischemic MR.

Live three-dimensional paediatric intraoperative epicardial echocardiography as a guide to surgical repair of atrioventricular valves

Real-time three dimensional echocardiography is increasingly used for imaging patients with congenital cardiac malformations. One of the limitations of a transthoracic approach is that intervening structures can impact on the quality of the images obtained. We hypothesised that, during surgery, epicardial three-dimensional echocardiography would provide images of high quality. We report our findings in eight children or young adults, with weights ranging from 2.8 to 70 kilograms, in whom we used this approach. In all cases, we obtained images of good quality, which could be analysed rapidly in the operating room. Of the eight cases, seven had echocardiographic findings which matched exactly the surgical findings. The remaining child had been diagnosed echocardiographically with a cleft in the aortic leaflet of the mitral valve, but was found at surgery to have a double orifice in the valve.

The use of live three-dimensional Doppler echocardiography in the measurement of cardiac output: An in vivo animal study

The purpose of this study was to investigate whether cardiac output (CO) could be accurately computed from live three-dimensional (3-D) Doppler echocardiographic data in an acute open-chested animal preparation.The accurate measurement of CO is important in both patient management and research. Current methods use invasive pulmonary artery catheters or two-dimensional (2-D) echocardiography or esophageal aortic Doppler measures, with the inherent risks and inaccuracies of these techniques.Seventeen juvenile, open-chested pigs were studied before undergoing a separate cardiopulmonary bypass procedure. Live 3-D Doppler echocardiography images of the left ventricular outflow tract and aortic valve were obtained by epicardial scanning, using a Philips Medical Systems (Andover, Massachusetts) Sonos 7500 Live 3-D Echo system with a 2.5-MHz probe. Simultaneous CO measurements were obtained from an ultrasonic flow probe placed around the aortic root. Subsequent offline processing using custom software computed the CO from the digital 3-D Doppler DICOM data, and this was compared to the gold standard of the aortic flow probe measurements.One hundred forty-three individual CO measurements were taken from 16 pigs, one being excluded because of severe aortic regurgitation. There was good correlation between the 3-D Doppler and flow probe methods of CO measurement (y = 1.1x - 9.82, R(2) = 0.93).In this acute animal preparation, live 3-D Doppler echocardiographic data allowed for accurate assessment of CO as compared to the ultrasonic flow probe measurement.

A Comparative Study of Imaging Techniques in Aortic Dissection, DeBakey Type I: Intraoperative Live Three-Dimensional Epicardial Echocardiography, Multiplane Transesophageal Echocardiography, and Multislice Computed Tomography

: To compare the accuracy of intraoperative live 3-dimensional epicardial echocardiography, multiplane transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) imaging in the detection of thoracic aortic dissection, site of intimal tear, and involvement of arch vessel. : Of 24 patients studied from October 2003 to September 2004, 12 had aortic dissection. They were examined preoperatively with contrast material-enhanced MSCT and multiplane TEE. Intraoperative live 3-dimensional epicardial echocardiographic evaluation of the ascending aorta and arch was performed. Imaging results in terms of detection of aortic dissection, site of intimal tear, and involvement of coronary arteries and arch vessels were confirmed at intraoperative exploration by the operating surgeon as the reference standard. : Sensitivity in the detection of thoracic aortic dissection was 100% for all techniques. Specificity was 92%, 92%, and 100% for live 3-dimensional epicardial echocardiography, multiplane TEE, and MSCT imaging, respectively. In the assessment of aortic arch vessel involvement, sensitivity was 92%, 58%, and 92%, and specificity was 75%, 50%, and 83%, respectively. For the detection of the site of intimal tear, sensitivity was 92%,92%, and 58%, and specificity was 83%,75%, and 50%, respectively. : Intraoperative live 3-dimensional epicardial echocardiography is as valuable as multiplane TEE and MSCT imaging in the detection of thoracic aortic dissection. In the assessment of the aortic arch vessel involvement, MSCT and live 3-dimensional epicardial echocardiography are superior (P < 0.05), whereas live 3-dimensional epicardial echocardiography and TEE are superior in detection of site of intimal tear (P < 0.05).

Live Three‐Dimensional Echocardiography of the Human Fetus

The purpose of this study was to investigate the feasibility of using a new three-dimensional ultrasound system to perform fetal echocardiographic examination in real time. The device consisted of a Philips Sonos 7500 (Andover, MA) ultrasound system and a 4 MHz, 4X matrix transducer. The study was approved by the Institutional Review Board and was performed with the informed consent of the mother. The study population consisted of 12 singleton fetuses with gestational ages of 16-37 weeks. Of these, ten fetuses had normal cardiac anatomy, one had complete atrioventricular septal defect, and the other a thickened tricuspid valve. The system allowed comprehensive visualization of fetal cardiac anatomy and color Doppler flow unattainable by two-dimensional approaches. This preliminary investigation suggests that live three-dimensional fetal echocardiography could be a significant tool for prenatal diagnosis and assessment of congenital heart disease in the human fetus.