Time Three-dimensional Transthoracic Echocardiography Research Articles

Three-dimensional transthoracic echocardiographic identification of individual cusps of the pulmonary valve: Potential misidentification by the two-dimensional technique.

We demonstrate the incremental value of live/real time three-dimensional transthoracic echocardiography (3DTTE) over the two-dimensional modality in the identification of all three cusps of the pulmonary valve in patients in whom only two leaflets could be detected by the latter technique. This was because of the ability of 3DTTE to view the cusps enface permitting assessment of relationship to one another and the surrounding cardiac structures. In addition, 3DTTE showed not only the potential errors that can occur in pulmonary valve cusp identification when the two-dimensional modality is used alone but also how some of these errors can be avoided by paying attention to the surrounding structures.

Safety of nifedipine in threatened preterm labor: Investigation by three-dimensional echocardiography.

To evaluate atrial and ventricular parameters using real time three-dimensional transthoracic echocardiography (RT3DTTE) in women treated with nifedipine in the early third trimester (III-T) of pregnancy. A prospective single-subject design study in a university-affiliated hospital, where each participant served as her own control. We studied 25 pregnant women at a gestational age of 25-33weeks with TPTL prior to vs 48hours postnifedipine treatment. Two-dimensional transthoracic echocardiography (2DTTE) and RT3DTTE were used to study 3D left atrial (LA) volumes and indexes, emptying fraction, left ventricular and LA cavities, and total vascular resistance (TVR). Two-dimensional transthoracic echocardiography showed a significant increase in LA area (from 15.2±2.62 to 16.16±2.21mm2 , P=.02) before vs after nifedipine; RT3DTTE showed a significant change in LA end-diastolic volume index (from 23.7±4.2 to 26.75±3.8mL/m2 , P=.008). LA end-systolic volume and index were not significantly different before vs after nifedipine (from 24.56±8 to 25.3±5.5mL, from 13.6±5.3 to 14.8±3.4mL/m2 ); P>.05, respectively. E/a ratio, E-tdi, and E/E-tdi did not change significantly ([from 2.54±4.46 to 2.54±4.1], [from 11.9±1.9 to 11.9±2], [from 7.8±1.4 to 7.6±1.1], respectively, P>.05). Tricuspid annular plane systolic excursion (TAPSE) did not change significantly from 23.77±4.2 to 23.9±3.3, P=.1. There was a significant decrease in pulmonary pressure (from 25.4±4.2 to 23±2.5mmHg, P=.02), in mean arterial pressure (from 80±4 to 76±3mmHg, P<.001) and in TVR (from 1160±260 to 1050±206dynes/cm-5 , P=.04). According to RT3DTTE measurements, in pregnant women treated with nifedipine for tocolysis, there were no detrimental cardiovascular effects detected 48hours postnifedipine treatment. RT3DTTE could show accurately the compensatory response of the left heart to the cardiovascular changes induced by treatment with nifedipine.

Incremental Value of Three-Dimensional over Two-Dimensional Transthoracic Echocardiography in the Assessment of Cor Triatriatum Sinister in a Child

A 2.5-year-old boy presented with frequent hospitalizations due to recurrent respiratory tract infections with dyspnea. A fibromuscular membrane dividing the left atrium with obstruction of left atrial inflow to the left ventricle was documented by two-dimensional transthoracic echocardiography (2DTTE). Live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over 2DTTE by providing en face views of the 2 obstructing orifices in the membrane enabling accurate assessment of their position, shape and size. 3DTTE also showed clearly the location of the membrane superior and proximal to the left atrial appendage which was not well delineated by 2DTTE. In addition, 3DTTE demonstrated the full extent of the left atrial appendage and careful sequential cropping of the 3D dataset showed it to have 2 distinct lobes and no thrombus. These findings provided comprehensive assessment of the lesion and were helpful in surgical decision making and planning.

Real Time Three-Dimensional Transthoracic Echocardiography of Ruptured Left Sinus of Valsalva Aneurysm to Left Ventricle

Aneurysms arising from the sinus of Valsalva are a rare cardiac defect that can present with various signs and symptoms, and if not diagnosed and treated rapidly can lead to fatal outcomes. Unruptured aneurysms are usually asymptomatic and found incidentally during diagnostic studies. More commonly, aneurysm of sinus of Valsalva is detected after the occurrence of rupture. Echocardiography has become the investigative tool of choice for this condition, not only for diagnosis but also for quantification of severity. We hereby report a rare case of a 15-year-old patient presenting with complaints of effort dyspnea and palpitations. Two-dimensional transthoracic echocardiography (TTE) showed aneurysmal dilatation of left sinus of Valsalva which had ruptured into the left ventricle. Also, there was an intimal flap within the sinus of Valsalva aneurysm. The anatomical relationship between the aorta, aneurysm, and the left ventricle as well as the intimal flap within the aneurysm was clearly delineated with the help of three-dimensional TTE. After confirmation of the diagnosis with multidetector computed tomography, patient underwent successful surgical repair of the defect.

Assessment of quadricuspid aortic valve with real time three-dimensional transthoracic echocardiography

Assessment of quadricuspid aortic valve with real time three-dimensional transthoracic echocardiography

Cardiac Device-Related Invasive Aspergilloma Assessed By Live/Real Time Three-Dimensional Transthoracic Echocardiography

Cardiac device-related infection caused by Aspergillus species is a rare finding associated with high mortality. Prompt recognition and treatment is imperative, but difficult as blood cultures are often negative and diagnosis requires a high index of suspicion. Live/real time three-dimensional transthoracic echocardiography (3DTTE) provides incremental knowledge in the characterization of valvular vegetations. Here, we provide a detailed description of an invasive cardiac device-related infection caused by Aspergillus fumigatus using 3DTTE. Findings described here highlight the role for 3DTTE in the prompt diagnosis of invasive cardiac Aspergillus infections as well as surgical planning in such cases.

Two‐ and Three‐Dimensional Transthoracic Echocardiography in the Assessment of Aortic Arch Vasum Vasi to Pulmonary Artery Fistula

We report an elderly patient presenting with a stroke and also hemolytic anemia secondary to mitral and tricuspid valve repair 3 years earlier, in whom two-dimensional transesophageal echocardiography (2DTEE) suspected a fistula into the pulmonary artery (APAF) from the posterior wall of the aortic arch. For further assessment, two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were performed. 2DTTE showed findings similar to 2DTEE. Color Doppler guided continuous-wave Doppler showed continuous flow throughout the cardiac cycle with systolic preponderance across the fistula with a small peak pressure gradient of 22 mmHg. Sequential systematic cropping of the 3D datasets obtained from 3DTTE confirmed that the flow signals originated from the posterior wall of the aortic arch and not the lumen. Thus, 3DTTE served to increase the confidence level that the fistula most likely originated from a vasum vasi in the wall of the aortic arch. To our knowledge, this type of fistula has not been reported previously. Fistulas from the aortic lumen to the pulmonary artery are also rare and so far only 24 cases have been reported in the literature. These are also reviewed by us.

Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of the Involvement of Cardiac Valves and Chambers in Carcinoid Disease

We present an adult with metastatic carcinoid disease affecting the heart, in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over two-dimensional transthoracic echocardiography (2DTTE). Initial 2DTTE was able to demonstrate severe pulmonic and tricuspid regurgitation, but was unable to visualize the posterior leaflet of the tricuspid valve or the right (right anterior) leaflet of the pulmonic valve. Further analysis with 3DTTE demonstrated thickening, restricted mobility, and noncoaptation of all three leaflets of both the tricuspid and the pulmonary valves. En face viewing of tricuspid and pulmonary regurgitation vena contractas permitted more reliable quantification of regurgitation severity. In addition, localized, linear, echogenic areas consistent with carcinoid deposits were noted along the inner walls of the right atrium, atrial septum, and inferior vena cava. To the best of our knowledge, endocardial carcinoid deposits have never been reported by 2D or 3D echocardiography. En face viewing of these deposits by 3DTTE enabled measurement of their dimensions and areas. Subcostal examination also identified large circumscribed hepatic lesions consistent with metastatic disease. Neither the carcinoid deposits nor the metastatic lesions were detected by 2DTTE. This case demonstrates the usefulness of 3DTTE as a supplement to 2DTTE in more comprehensively assessing carcinoid involvement of the heart.

Incremental Utility of Real Time Three‐Dimensional Tranthoracic Echocardiography in the Assessment of Congenitally Malformed Aortic Valve

To study the feasibility and additional value of real time three-dimensional transthoracic echocardiography (RT3D-TTE) for anatomical and functional assessment of malformed aortic valve (AV) compared to conventional two-dimensional TTE (2D-TTE). Malformed AV was evaluated in 35 patients (mean age 18 ± 9.5 years, 70% male) by both 2D-TTE and RT3D-TTE. The anatomical definition of aortic cusps (number, direction, and commissures) was evaluated by a 3-point visualization score (1: nonvisualized, 2: inadequate, 3: adequate). 2D-TTE and RT3D-TTE measurements included AV area and maximum diameters of both AV annulus and left ventricular outflow tract (LVOT). Adequate visualization of AV cusps was achieved in 86% of patients by RT3D-TTE compared to 63% by 2D-TTE. The mean and median visualization score obtained by RT3D-TTE were higher than that by 2D-TTE. The opening of commissures was detected in (80%) of patients by RT3D-TTE compared to (34%) by 2D-TTE. AV area planimetry could be obtained in 77% of patients by RT3D-TTE compared to 43% by 2D-TTE. RT3D-TTE visualization score of AV cusps and commissures showed better interobserver agreement (Kappa: 0.62 and 0.72, respectively) than 2D-TTE (0.58 and 0.69, respectively). RT3D-TTE and 2D-TTE measurements of AV annulus and LVOT were well correlated (r = 0.85; P < 0.001) but the RT3D-TTE measurements were significantly larger than that obtained by 2D-TTE (2.05 ± 0.7 cm and 2.5 ± 0.86 cm vs 1.94 ± 0.67 cm and 1.98 ± 0.74 cm; P < 0.01). RT3D-TTE is a feasible technique that allows comprehensive quantitative and qualitative assessment of malformed AV.

Delineation of the Etiology of a Mass‐Like Echo Density in the Left Ventricle Using Three‐Dimensional Transthoracic Echocardiography

Live/real time three-dimensional transthoracic echocardiography (3DTTE) provides an incremental value in the delineation of various cardiac pathologies. In this study, two-dimensional transthoracic echocardiography (2DTTE) of a 56-year-old patient showing a prominent echo density suggestive of a mass in the left ventricle probably attached to the ventricular side of the anterior mitral leaflet, is reported. Systematic cropping of the 3DTTE dataset showed the mass to be a calcified mitral strut chord viewed in cross section. This is well visualized in the accompanying movie clip. This case highlights the advantage of 3DTTE in which the whole of the ventricle including the mitral valve apparatus is captured in the dataset facilitating cropping at any desired angulation.

Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Assessment of the Involvement of Cardiac Valves and Chambers in Carcinoid Disease

We present an adult with metastatic carcinoid disease affecting the heart, in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over two-dimensional transthoracic echocardiography (2DTTE). Initial 2DTTE was able to demonstrate severe pulmonic and tricuspid regurgitation, but was unable to visualize the posterior leaflet of the tricuspid valve or the right (right anterior) leaflet of the pulmonic valve. Further analysis with 3DTTE demonstrated thickening, restricted mobility, and noncoaptation of all three leaflets of both the tricuspid and the pulmonary valves. En face viewing of tricuspid and pulmonary regurgitation vena contractas permitted more reliable quantification of regurgitation severity. In addition, localized, linear, echogenic areas consistent with carcinoid deposits were noted along the inner walls of the right atrium, atrial septum, and inferior vena cava. To the best of our knowledge, endocardial carcinoid deposits have never been reported by 2D or 3D echocardiography. En face viewing of these deposits by 3DTTE enabled measurement of their dimensions and areas. Subcostal examination also identified large circumscribed hepatic lesions consistent with metastatic disease. Neither the carcinoid deposits nor the metastatic lesions were detected by 2DTTE. This case demonstrates the usefulness of 3DTTE as a supplement to 2DTTE in more comprehensively assessing carcinoid involvement of the heart.

Transthoracic Real Time Three‐Dimensional Echocardiography in Impella Placement

A 33-year-old patient with nonischemic cardiomyopathy presented with cardiogenic shock requiring percutaneous left ventricular assist device placement despite inotropic support. Under transthoracic two-dimensional echocardiographic guidance, an Impella 2.5 L heart pump was placed. The inflow catheter was distal to the aortic valve, however patient remained in shock. Real time three-dimensional transthoracic echocardiography showed the inflow catheter imbedded into the papillary muscle causing inlet occlusion. By cropping 3D data set in multiple planes, a better spatial visualization of the inflow catheter and its distance from the aortic valve was easily obtained and the device was adjusted.

Role of Live/Real Time Three‐Dimensional Transthoracic Echocardiography in Pericardial Disease

Despite the high sensitivity of two-dimensional transthoracic echocardiography (2DTTE) in diagnosing pericardial effusion, it has limitations in assessing its size and extent and in evaluating other pericardial pathologies. There are only limited reports so far, but live/real time three-dimensional transthoracic Echocardiography (3DTTE) has shown promise and potential advantages over 2DTTE in certain clinical situations. With its ability to crop and view cardiac structures from any desired angulation it offers incremental value in assessing the anatomy of the pericardium including echo densities within the effusion, fibrinous bands, and loculated effusions. It offers significant supplemental information over 2DTTE in clinical scenarios like post cardiac surgery follow up of hemopericardium, quantification of the effusion, evaluation of pericardial masses including granuloma, differentiating pericardial effusion from ascites and pleural effusion and in studying the extent of the disease in constrictive pericarditis. However, comprehensive studies are needed to further define its role in daily clinical practice.

Usefulness of Three-Dimensional Echocardiography for Evaluation of Pathological Mass in the Right Atrium

The authors present a case of 51-year-old male patient with symptoms of congestive heart failure. Two-dimensional transthoracic echocardiography (2D TTE) at the time of admission revealed a spherical, highly mobile structure in the right atrium (4.5 cm in diameter). Despite using multiple views it was impossible to distinguish if this structure had a stalk or was free-floating. The real time three-dimensional transthoracic echocardiography (3D TTE) revealed the presence of thin stalk attached to the roof of the right atrium. Guidance of 2D TTE by 3D TTE findings finally allowed the recognition of the stalk in modified subcostal view.

Real Time Three‐Dimensional Transthoracic Echocardiography Evaluation in a Patient with Congenital Pulmonary Vein Stenosis

Although real time three-dimensional transthoracic echocardiography (RD-3DTTE) has been used in children with complex congenital heart diseases, the benefit of RD-3DTTE as a vision of the pulmonary veins still requires further evaluation. We present here, a 3-year-old girl with a stenosis of the left upper pulmonary vein (LUPV). Excellent images were obtained rapidly by RD-3DTTE that successfully visualized the narrowing at the junction of the LUPV. The result was demonstrated by MRI, cardiac catheterization, and operation. RD-3DTTE is a feasible and promising technique in evaluating pulmonary veins in children.

Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Assessment of Inferior Vena Cava and Hepatic Vein Thrombosis in Sickle Cell Disease

We describe the value of live/real time three-dimensional transthoracic echocardiography (3DTTE) over two-dimensional transthoracic echocardiography (2DTTE) in the assessment of inferior vena cava (IVC) and hepatic vein (HV) obstruction in a patient with sickle cell disease. 3DTTE provided additional information when compared to 2DTTE by (1) identifying the obstructing lesion as a likely thrombus, (2) by providing assessment of anatomical severity of IVC lumen obstruction since the thrombus could be visualized en face also, and (3) identifying an area of increased mobility of a portion of the thrombus suggesting greater risk of embolization. (Echocardiography 2010;27:594-596).

Usefulness of Live/Real Time Three-Dimensional Transthoracic Echocardiography in the Assessment of Descending Thoracic Aorta Graft Dehiscence

We report the usefulness of live/real time three-dimensional transthoracic echocardiography to identify endovascular graft showing leakage not visualized using two-dimensional transthoracic echocardiography.

Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Findings in an Adult with Complete Atrioventricular Septal Defect

Live/real time three-dimensional transthoracic echocardiography provided incremental value over two-dimensional transthoracic echocardiography in an adult patient with complete atrioventricular (AV) septal defect by (1) making a confident diagnosis of Rastelli type A defect, (2) providing en face view of all the five leaflets of the common AV valve, (3) diagnosing left ventricle to right atrial shunt, and (4) permitting more accurate quantitative assessment of regurgitant lesions.

Live/Real Time Three‐Dimensional Transthoracic Echocardiographic Assessment of Transposition of the Great Arteries in the Adult

We studied 11 adult patients with dextro-transposition and 5 adult patients with levo-transposition (corrected transposition) of the great arteries with real time two-dimensional (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE). All patients with dextro-transposition underwent a Mustard or Senning procedure during infancy. Incremental findings provided by 3DTTE and not delineated by 2DTTE were (a) comprehensive examination of all three leaflets of the tricuspid valve including the detection and measurement of anatomic defects in the leaflets and the assessment of systolic noncoaptation and segmental prolapse; (b) en face viewing and measurement of vena contracta areas of the valvular regurgitation jets and the assessment of regurgitant volumes; (c) en face viewing of the intra-atrial baffle and localization and measurement of baffle defects as well as the measurement of vena contractas of the baffle leaks; (d) recognition of a bicuspid pulmonary valve; and (e) the quantitative assessment of left ventricular outflow tract obstruction. 3DTTE appears to be a useful noninvasive modality which could supplement 2DTTE in the comprehensive assessment of adult patients with transposition of the great arteries.

Embolization of Atrial Septal Occluder Device into the Pulmonary Artery: A Rare Complication and Usefulness of Live/Real Time Three‐Dimensional Transthoracic Echocardiography

Percutaneous closure of atrial septal defects (ASD) in adults has emerged as an alternative to surgery. We report a rare complication of an atrial septal occluder device embolization into the pulmonary artery which was detected by fluoroscopy and echocardiography. The potential usefulness of live/real time three-dimensional transthoracic echocardiography in the management of patients undergoing percutaneous ASD occlusion is described.