Transthoracic Real-time Three-dimensional Echocardiography Research Articles

Real Time Three‐Dimensional Transthoracic Echocardiography for Guiding Amplatzer Septal Occluder Device Deployment in Patients with Atrial Septal Defect

Transcatheter Amplatzer septal occluder (ASO) device closure of atrial septal defects (ASDs) has traditionally been guided by two-dimensional transesophageal echocardiography (2D-TEE) and intracardiac echocardiography (ICE) modalities. Real time three-dimensional transthoracic echocardiography (RT3D-TTE) provides rotating images to define ASD and adjacent structures with potential as an alternative to 2D-TEE or ICE for guiding the device closure of ASD. Our aim was to assess the feasibility and effectiveness of RT3D-TTE in parasternal four-chamber views to guide ASO device closure of ASD. From July 2004 to August 2005, 59 patients underwent transcatheter ASO device closure of ASD. The first 30 patients underwent 2D-TEE guidance under general anesthesia and the remaining 29 patients underwent RT3D-TTE guidance with local anesthesia. All interventions were successfully completed without complications. The clinical characteristics and transcatheter closure variables of RT3D-TTE and 2D-TEE were compared. Echocardiographic visualization of ASD and ASO deployment was found to be adequate when using either methods. Catheterization laboratory time (39.1 +/- 5.4 vs 78.8 +/- 14.1 minutes, P < 0.001) and interventional procedure length (7.6 +/- 4.2 vs 15.3 +/- 2.9 minutes, P < 0.001) were shortened by using RT3D-TTE as compared with 2DE-TEE. There was no difference in the rate of closure following either method, assessed after a 6-month follow-up. The maximal diameter measured by RT3D-TTE and 2D-TEE was correlated well with a balloon-stretched ASD size (y = 0.985x + 0.628, r = 0.924 vs y = 0.93x + 2.08, r = 0.885, respectively). RT3D-TTE may be a feasible, safe, and effective alternative to the standard practice of using 2D-TEE to guide ASO deployment.

Correlations with operative anatomy of real time three-dimensional echocardiographic imaging of congenital aortic valvar stenosis

To define the anatomic characteristics of the congenitally malformed and severely stenotic aortic valve using trans-thoracic real time three-dimensional echocardiography, and to compare and contrast this with the valvar morphology as seen at surgery. Prospective cross-sectional observational study. Tertiary centre for paediatric cardiology. All patients requiring aortic valvotomy between December 2003 and July 2004 were evaluated prior to surgery with three-dimensional echocardiography. Full volume loop images were acquired using the Phillips Sonos 7500 system. A single observer analysed the images using "Q lab 4.1" software. The details were then compared with operative findings. We identified 8 consecutive patients, with a median age of 16 weeks, ranging from 1 day to 11 years, with median weight of 7.22 kilograms, ranging from 2.78 to 22 kilograms. The measured diameter of the valvar orifice, and the number of leaflets identified, corresponded closely with surgical assessment. The sites of fusion of the leaflets were correctly identified by the echocardiographic imaging in all cases. Fusion between the right and non-coronary leaflets was identified in half the patients. Dysplasia was observed in 3 patients, with 1 patient having nodules and 2 shown to have excrescences. At surgery, nodules were excised, and excrescences were trimmed. The dysplastic changes correlated well with operative findings, though statistically not significant. We recommend trans-thoracic real time three-dimensional echocardiography for the assessment of the congenitally malformed aortic valve, particularly to identify sites of fusion between leaflets and to measure the orificial diameter. The definition of nodularity, and the prognosis of nodules based on the mode of intervention, will need a comparative study of patients submitted to balloon dilation as well as those undergoing surgical valvotomy.

ESC Textbook of Cardiovascular Medicine

John Camm, Thomas F. Luscher, Patrick W. Serruys, eds 1136 pages. Oxford, UK: Blackwell Publishing; 2006. $295. ISBN 1-4051-2695-7 Editor’s Note: In our effort to provide an insightful, balanced, and constructively critical review of the new first edition of the ESC Textbook of Cardiovascular Medicine edited by Drs A. John Camm, Thomas F. Luscher, and Patrick W. Serruys that was published under the auspices of the European Society of Cardiology by Blackwell Publishing Ltd (2006), we have obtained the opinions of 3 distinguished senior cardiologists, Drs Gottlieb Friesinger, Desmond Julian, and Elliot Rapaport, to serve as a Select Panel for Review. To ensure the book was read in its entirety, the text was divided into thirds and apportioned equally to each reviewer; all 3 reviewers were assigned 4 chapters in common to read as well. This summary review by 3 individuals, each of whom is internationally recognized for expertise in the broad field of general cardiology, is offered in the spirit of helping the ESC achieve its stated objective of providing a textbook that is successful in covering the knowledge that should be required of all general cardiologists. ### General Comments This textbook is primarily targeted at the specific audience of those wishing to be accredited with the European Board for Accreditation in Cardiology (EBAC). It is not intended to be a work of reference, but, as stated in the foreword, of producing “a clinically focused resource for general cardiologists and trainees.” It presents 36 chapters within 1092 pages, each authored by anywhere from 2 to 6 multinational collaborating members of the European Society of Cardiology. One of its remarkable achievements in addition to the high standard of writing is its superb illustrations, figures, and tables that appear on virtually every page. They are well placed within the text and contribute in making …

Transthoracic Real‐Time Three‐Dimensional Echocardiography in the Diagnosis and Description of Noncompaction of Ventricular Myocardium

Numerous modalities have been used to diagnose and characterize noncompaction of ventricular myocardium (NCVM) including magnetic resonance imaging, two-dimensional echocardiography (2DE), contrast-enhanced 2DE, and angiography. The current case series examines the use of real-time three-dimensional transthoracic echocardiography (RT-3DE) in four such cases of NCVM. From December 2003 to March 2004, we performed RT-3DE using a Philips Sonos 7500 echocardiographic scanner equipped with a 2-4 MHz 3D matrix array transthoracic probe, to evaluate four patients with NCVM. The real-time 3D transthoracic probe allows for dataset acquisition in an ultrasound wedge, which can be manipulated instantaneously. In addition, complete 3D volume rendering is acquired, allowing for volumetric imaging. The age range of the patients was 2 months to 42 years. One patient had the codiagnoses of coarctation of the aorta and bicuspid aortic valve. In all four patients, RT-3DE enabled diagnosis and provided detailed characterization of the affected myocardium. Entire trabecular projections and intertrabecular recesses were easily visualized simultaneously, and endocardial borders were clearly demarcated. Wall motion abnormalities of the affected myocardium were clearly visualized. The compacted and noncompacted portions of the myocardium could be differentiated well. Our study provides preliminary data highlighting the utility and feasibility of RT-3DE in the clinical characterization of NCVM. The complex 3D nature of this disorder and the endocardial hypertrabeculation were more readily visualized than with 2DE.

Advances in the Evaluation of Mitral Complex Geometry:Insights from Transthoracic Real-time Three-dimensional Echocardiography

Advances in the Evaluation of Mitral Complex Geometry:Insights from Transthoracic Real-time Three-dimensional Echocardiography

Geometric Differences of the Mitral Valve Tenting Between Anterior and Inferior Myocardial Infarction with Significant Ischemic Mitral Regurgitation: Quantitation by Novel Software System with Transthoracic Real-time Three-dimensional Echocardiography

We sought to investigate the 3-dimensional geometric differences of mitral leaflet tenting in ischemic mitral regurgitation, comparing inferior and anterior myocardial infarction (MI). Using real-time 3-dimensional echocardiography, we obtained transthoracic volumetric images for patients with significant ischemic mitral regurgitation (9 inferior and 7 anterior). With our novel software system, 3-dimensional images of the leaflets were reconstructed for quantitation. Mitral leaflet configuration was then represented in contour in which the degree of the tenting could be observed. Calculated percent of tethered leaflet area (>5-mm tenting from the annular level) was compared in inferior and anterior MI. Percent of tethered leaflet area was significantly smaller in inferior than anterior MI, reflecting the localized leaflet tenting in inferior MI (16.7 +/- 18.8% vs 38.9 +/- 9.7%, P = .01). In anterior MI, mitral valve leaflets were widely tethered toward the left ventricle, in contrast with inferior MI showing localized tenting of the leaflet.

Demonstração do mecanismo da terapia de ressincronização ventricular com ecocardiografia tridimensional em tempo real em paciente com insuficiência cardíaca

We report the case of a 66-year-old man with heart failure NYHA class IV treated with biventricular pacing for cardiac resynchronization. The patient was evaluated by real-time three-dimensional transthoracic echocardiography before and 48 hours after pacemaker implantation. The use of three-dimensional echocardiography contributed to understanding the underlying mechanism involved in cardiac resynchronization therapy by demonstrating enhanced synchrony of myocardial segments, which resulted in the patient's clinical improvement.

Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography

We sought to investigate the geometric changes of the mitral leaflets and annulus, clarify the maximum tenting site of the leaflets, and quantify the valve tenting in ischemic mitral regurgitation (MR) using three-dimensional (3D) echocardiography. Although the understanding of the mechanisms of ischemic MR has advanced recently, the geometric changes of the mitral leaflets and annulus have been assessed by two-dimensional echocardiography in the clinical setting, despite the unique configuration of the leaflets and annulus. Utilizing real-time 3D echocardiography, we obtained transthoracic volumetric images in 12 patients with ischemic MR presenting with global left ventricular dysfunction and in 10 controls. Original software was used to crop the 3D data into 18 radial planes, and we marked the mitral annulus and leaflets in each plane in mid-systole. The 3D images of the leaflets and annulus were reconstructed for the quantitative measurements. In ischemic MR, the annulus flattened with apparent tenting of the leaflets. Maximum and mean tenting length were longer and tenting volume was larger in ischemic MR than control subjects (maximum tenting length: 9.8 +/- 2.0 mm vs. 3.1 +/- 1.2 mm, p < 0.0001, mean tenting length: 3.7 +/- 0.9 mm vs. 0.7 +/- 0.5 mm, p < 0.0001, tenting volume: 4.09 +/- 1.22 ml vs. 0.45 +/- 0.29 ml, p < 0.0001). The maximum tenting site was located in anterior leaflet in all patients. We clearly demonstrated 3D geometric deformity of the mitral leaflets and annulus in ischemic MR using novel software for creating images by 3D echocardiography. This technique will be helpful in making a proper decision for the surgical strategy in each patient.

Value of real-time three-dimensional transthoracic echocardiography in comparison to three-dimensional transesophageal echocardiography for planning of mitral valve surgery

Objectives: We evaluated the value of real-time three-dimensional (3D) transthoracic echocardiography (TTE) compared to 3D transesophageal echocardiography (TEE) performed offline for planning of mitral valve surgery.

The Structural and Dynamic Recognition of Discrete Subaortic Stenosis by Real-Time Three-dimensional Transthoracic Echocardiography

Discrete subaortic stenosis is a rare condition to cause left ventricular outflow obstruction. It is sometimes difficult to diagnose it because conventional transthoracic echocardiography may fail to show its 3-dimensional feature. We document the feasibility of on-line 3-dimensional transthoracic echocardiography, by which we can obtain the important 3-dimensional structural and dynamic information of discrete subaortic stenosis.

High-resolution transthoracic real-time three-dimensional echocardiography. Quantitation of cardiac volumes and function using semi-automatic border detection and comparison with cardiac magnetic resonance imaging

High-resolution transthoracic real-time three-dimensional echocardiography. Quantitation of cardiac volumes and function using semi-automatic border detection and comparison with cardiac magnetic resonance imaging

High-resolution transthoracic real-time three-dimensional echocardiography: Quantitation of cardiac volumes and function using semi-automatic border detection and comparison with cardiac magnetic resonance imaging

ObjectivesWe sought to validate high-resolution transthoracic real-time (RT) three-dimensional echocardiography (3DE), in combination with a novel semi-automatic contour detection algorithm, for the assessment of left ventricular (LV) volumes and function in patients. BackgroundQuantitative RT-3DE has been limited by impaired image quality and time-consuming manual data analysis. MethodsTwenty-four subjects with abnormal (n = 14) or normal (n = 10) LVs were investigated. The results for end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) obtained by manual tracing were compared with the results determined by the semi-automatic border detection algorithm. Moreover, the results of the semi-automatic method were compared with volumes and EF obtained by cardiac magnetic resonance imaging (CMRI). ResultsExcellent correlation coefficients (r = 0.98 to 0.99) and low variability (EDV −1.3 ± 8.6 ml; ESV −0.2 ± 5.4 ml; EF −0.1 ± 2.7%; p = NS) were observed between the semi-automatically and manually assessed data. The RT-3DE data correlated highly with CMRI (r = 0.98). However, LV volumes were underestimated by RT-3DE compared with CMRI (EDV −13.6 ± 18.9 ml, p = 0.002; ESV −12.8 ± 20.5 ml, p = 0.005). The difference for EF was not significant between the two methods (EF 0.9 ± 4.4%, p = NS). Observer variability was acceptable, and repeatability of the method was excellent. ConclusionsThe RT-3DE, in combination with a semi-automatic contour tracing algorithm, allows accurate determination of cardiac volumes and function compared with both manual tracing and CMRI. High repeatability suggests applicability of the method for the serial follow-up of patients with cardiac disease.

1113-161 Assessment of the left atrial appendage using transthoracic real-time three-dimensional echocardiography

1113-161 Assessment of the left atrial appendage using transthoracic real-time three-dimensional echocardiography

838 Direct measurement of left ventricular outflow tract by newly developed transthoracic real-time-3D-echocardiography increases accuracy in assessment of aortic valve stenosis

Background: Evaluation of aortic valve stenosis is a major clinical application of echocardiography. The widely employed continuity equation requires determination of the left ventricular outflow tract (LVOT) area. We aimed at testing whether direct area measurement in a volume data set is superior to conventional calculation from the LVOT diameter. Methods: We performed LVOT measurement in 20 normal subjects and 83 patients with moderate to severe aortic stenosis with a transthoracic real-time three-dimensional echocardiography (3D-TTE) technique in two systolic frames. The off-line 3D-evaluation allows full choice of section planes within the acquired volume data set. The aortic valve area was calculated from systolic LVOT areas. These results were compared to area values obtained by M-mode LVOT-diameters (area= π ⁎(d/2) 2 ). In addition, the calculated aortic valve orifices were compared to invasive measurements or direct planimetry in the transthoracic or transesophageal examination. Results: Two independent observers found a reduction in LVOT area during systole (pb0.001). Often a more ellipsoid-like shaped LVOT resulted at end-systole which was shown by a reduction (pb0.001) of the LVOT longitudinal to oblique axis ratio. 3D-TTE determination of aortic valve orifice areas (mean difference: −0.04±0.09 cm 2 ) showed a lesser deviation from the invasively or planimetrically measured areas than conventionally calculated LVOT areas (mean difference: −0.1±0.1 cm 2 ) using the continuity equation (pb0.001). Conclusions: The tested transthoracic 3D-echocardiography technique offers non-invasive measurement of the LVOT and aortic valve area based on the continuity equation during systole and thus improves accuracy and, additionally, agreement of aortic valvular area determination with invasive and direct measurements. © 2008 Elsevier Ireland Ltd. All rights reserved.

P2123 Transthoracic high-resolution real-time three-dimensional echocardiography for the analysis of regional left-ventricular wall motion patterns in patients with cardiac resynchronization therapy

P2123 Transthoracic high-resolution real-time three-dimensional echocardiography for the analysis of regional left-ventricular wall motion patterns in patients with cardiac resynchronization therapy

1846 Assessment of left-ventricular volumes and function using high-resolution transthoracic real-time three-dimensional echocardiography: comparison of semi-automatic border detection with manual contour tracing

1846 Assessment of left-ventricular volumes and function using high-resolution transthoracic real-time three-dimensional echocardiography: comparison of semi-automatic border detection with manual contour tracing

Transthoracic real-time three-dimensional echocardiography using the rotational scanning approach for data acquisition.

Transthoracic real-time three-dimensional echocardiography using the rational scanning approach for data acquisition became a feasible modality for cardiac imaging during the last 4 years. Several attempts for reconstruction of the heart have been made using different methods. In this study we evaluate the data acquisition using the rotational approach from the transthoracic window. Thirty-five children with congenital heart disease were enrolled in the study. All of them underwent complete two-dimensional and Doppler echocardiogram followed by three-dimensional reconstruction using rotational image acquisition. The rotational approach enabled us to acquire good data from subcostal, apical, and suprasternal notch positions by rotating the transducer from 0 degrees-180 degrees. Novel views of the atrioventricular valve, semilunar valve, atrial, and ventricular septi were established by spatial plane imaging from the three-dimensional echocardiography. This reconstruction enables spatial imaging of cardiac structures and deficiencies. Three-dimensional echocardiography will enhance the understanding of complex congenital heart disease.