Utility Of Three-dimensional Echocardiography Research Articles

The Utility of Three-Dimensional Echocardiography in the Assessment of Pulmonary Valve Function in a Novel “Hand-Made” Pulmonary Valve Conduit

The right ventricle to pulmonary artery valved conduit is a key component of surgeries to rehabilitate the right ventricular outflow tract in children with congenital heart disease. Evaluation of the conduit valve function forms a key part of follow-up evaluation of these children. We report the utility of three-dimensional transthoracic echocardiography to evaluate the conduit valve function in these children.

Utility of three-dimensional echocardiography and magnetic resonance imaging in the diagnosis of double-orifice tricuspid valve.

Duplication of atrioventricular valves involves the mitral valve more often than the tricuspid valve and is often associated with other cardiac defects. Double-orifice tricuspid valve (DOTV) is often identified in surgery or autopsy and missed on echocardiography, as the two orifices are orthogonal to the imaging plane. If suspected on echocardiography, it masquerades as mild tricuspid hypoplasia. Three-dimensional echocardiography and magnetic resonance imaging of a DOTV are presented.

Clinical Utility of Three-Dimensional Echocardiography for the Evaluation of Ventricular Function

The evaluation of ventricular function is a core component of 2-dimensional echocardiography (2DE). Given the known limitations of 2DE, a more accurate assessment of ventricular function has long been desired. Three-dimensional echocardiography (3DE) holds promise to fulfill this role while still maintaining the same benefits of low cost, portability, and efficiency of 2DE. Although 3DE has been investigated for over 30 years, the technology has seen little use in the modern clinical echocardiography lab. Although the benefit provided by the additional dimension of 2DE over M-Mode was immediately apparent, the clinical advantages of 3DE over 2DE have been difficult to appreciate. Several reasons for the lack of adoption include the learning curve, concerns about workflow, skepticism about clinical validity, and perceptions that the technology is too unrefined. Nonetheless, the past 2 decades have seen tremendous technical improvements in the field and a wealth of clinically applicable research. In particular, 3DE now has an established role in evaluating left ventricular systolic function. This review highlights the clinical relevancy of 3DE in evaluating ventricular function in terms of the history, relevant data, advantages, and the limitations of current generation 3DE.

‘Honeycomb appearance’ on three-dimensional transthoracic echocardiography as the landmark of left ventricular non-compaction: two case reports

IntroductionLeft ventricular non-compaction is a rare congenital heart disease, and is most commonly diagnosed via two-dimensional echocardiography according to echocardiographic criteria. Recently, transthoracic three-dimensional echocardiography has become available in the clinical setting.Case presentationWe present two isolated cases of left ventricular non-compaction from Japan (in an 84-year-old woman and 47-year-old man) that were confirmed by two-dimensional echocardiography, contrast-enhanced two-dimensional echocardiography, three-dimensional echocardiography and cardiac magnetic resonance imaging. In both cases, three-dimensional echocardiography successfully demonstrated the trabecular meshwork of the left ventricle, referred to as a ‘honeycomb appearance’.ConclusionsThree-dimensional echocardiography has the advantage of visualizing an en-face view of the trabecular meshwork, which is not possible with two-dimensional echocardiography. We further emphasize the clinical utility of three-dimensional echocardiography, which is not limited to just the observation of the trabeculations and inter-trabecular recesses, but can also visualize the trabecular meshwork with a ‘honeycomb appearance’.

Utility of three-dimensional echocardiography in assessing and predicting response to cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) can be a valuable treatment for heart failure. However, there are high nonresponse rates using current CRT inclusion criteria. To assess the value of three-dimensional echocardiography (3DE) in predicting response to CRT. Functional assessments and 3DE were performed in heart failure patients pre-CRT, 24 h post-CRT and six to 12 months after CRT. The dyssynchrony index (DI) was calculated as the SD of the time to minimum volume in 16 left ventricle segments corrected by heart rate. Response to CRT was defined as functional improvement (alive at late follow-up with improvement by one New York Heart Association class) and a decrease in left ventricular end-systolic volume by 15% or greater at six to 12 months follow-up. A total of 53 patients were enrolled. Average 3DE acquisition time was less than 5 min. Seventy-two per cent of patients showed functional improvement, while 43% showed functional and echocardiographic evidence of response. Baseline DI and the decrease in DI at 24 h were both correlated with reverse remodelling. Responders had higher baseline DI values compared with nonresponders (mean 16.8 versus 7.1, P<0.001), and showed a greater decrease in DI values at 24 h (mean decrease 7.9 versus 0.7, P<0.001). All responders had baseline DI values of greater than 10 (negative predictive value of 100%). A decrease in the DI value by more than 5 at 24 h in patients with a baseline DI of greater than 10 identified responders with a positive predictive value of 83%. 3DE may be valuable in predicting response to CRT. A baseline DI cut-off of greater than 10 in our patients excluded reverse remodelling to CRT. In addition, the decrease in DI at 24 h had a high positive predictive value for long-term response to CRT.

Assessments of Right Ventricular Volume and Function Using Three-Dimensional Echocardiography in Older Children and Adults With Congenital Heart Disease: Comparison With Cardiac Magnetic Resonance Imaging

The utility of three-dimensional echocardiography (3DE) for right ventricular (RV) assessment is uncertain in older children and adults with congenital heart disease (CHD), in whom the right ventricle is often dilated and dysfunction is common. RV assessments using 3DE were compared with manual tracing and automated border detection (ABD) with magnetic resonance imaging (MRI) as the reference method. Twenty-eight of 54 consecutive patients (52%; median age, 17 years) with CHD had adequate three-dimensional echocardiographic data sets for analysis. There were wide ranges of RV size (mean RV end-diastolic volume index, 143 +/- 43 mL/m(2)) and function (mean RV ejection fraction [EF], 48 +/- 10%) on MRI. End-diastolic volume was underestimated on 3DE by 20% (P < .001) and to a greater degree in larger ventricles (P < .001). There was no significant difference in EF measurements between 3DE methods and MRI except for ABD (-2.6 +/- 6, P = .03). The mean analysis time for ABD was 5 minutes, compared with 19 minutes for manual tracing (P < .0001). Approximately half the patients with CHD had adequate three-dimensional echocardiographic images. Three-dimensional echocardiography accurately estimated EF but underestimated volume, particularly when the right ventricle was dilated. ABD minimally underestimated EF but offered a significant reduction in analysis time.

Intraoperative Assessment of Perivalvular Mitral Regurgitation: Utility of Three-Dimensional Echocardiography

THE APPLICATION OF transesophageal echocardiography (TEE) for the assessment of prosthetic valve function is considered a category II indication.1 Although direct surgical examination of the prosthetic mitral valve is considered the “gold standard,” TEE provides a “dynamic” assessment of the valve under varying loading conditions.2 Three-dimensional (3D) TEE imaging may provide additional information to improve the description of prosthetic valve function and the location of perivalvular leaks. The incorporation of color-flow Doppler information in the 3D image may also help visualize the complex and eccentric mitral regurgitation (MR) jets.

Transthoracic 3-dimensional echocardiography in the assessment of subaortic stenosis due to a restrictive ventricular septal defect in double inlet left ventricle with discordant ventriculoarterial connections

To evaluate the accuracy and clinical utility of three-dimensional echocardiography in the assessment of the size and shape of the ventricular septal defect in double inlet left ventricle. We validated the technique in an autopsy study, and then performed a clinical investigation. Six autopsied hearts were immersed in a waterbath and examined with 3-dimensional echocardiography. We identified the cross-section within the dataset which optimally displayed the ventricular septal defect "en face", and compared its smallest and largest diameters, as well as its area. The ventricular septal defect was then filled with a silicone sealant and a section prepared for direct measurement. In patients, we measured the diameters and area of the ventricular septal defect in endsystole nad computed the aortic valvar area in endsystole from the cross-section showing the aortic valve "en face". Ten patients with double inlet left ventricle, aged between 2 and 15 years, were studied using rotational or parallel scanning. All patients had undergone banding of the pulmonary trunk at a mean age of 7 (3-36) days, usually at the time of repair of the coarctation. Two patients had undergone surgical enlargement of the ventricular septal defect prior to echocardiographic examination. The correlation between the areas of the ventricular septal defect in the specimens measured directly and by 3-dimensional echocardiography was r=0.98, with limits of agreement between -0.1-0.08 cm2. In the patients, the area of the defect was measured as 3.9+/-2 cm2, whereas the aortic valvar area was 2.6+/-0.9 cm2. The ratio between the areas was 1.5 (0.5-2.3). Three patients with areas of the ventricular septal defect smaller than those of the aortic valve had resting Doppler gradients between double inlet left ventricle and the aorta of 16, 20 and 30 mm Hgs, respectively. 3-dimensional echocardiography provides accurate assessment of the area of the ventricular septal defect in double inlet left ventricle, and is helpful in identifying patients with subaortic stenosis caused by restrictive defects.

Utility of three-dimensional echocardiography during balloon mitral valvuloplasty

Objectives. We investigated the role of three-dimensional echocardiography in assessing mitral valve anatomy in greater detail in patients immediately before and after balloon mitral valvuloplasty (BMV).Background. Three-dimensional echocardiography is a recently developed, evolving imaging technique that allows visualization of intracardiac structures from any perspective.Methods. We studied 19 patients undergoing BMV using transesophageal echocardiography (TEE) (Chicago, Illinois) to image the mitral valve. The TEE was interfaced to a TomTec three-dimensional workstation that allows electrocardiographic and respiratory cycle gated image acquisition. The acquired images are digitized, and after postprocessing a three-dimensional image is reconstructed. The mitral valve was viewed “en-face” as if looking up from the left ventricle.Results. The mean mitral valve area (by pressure half-time from the Doppler of the two-dimensional echocardiogram) increased after BMV from 0.86 ± 0.06 cm2to 2.07 ± 0.10 cm2, p < 0.0001. This was similar to the mitral valve areas obtained by planimetry from the three-dimensional images. The three-dimensional reconstructions showed a complete commissural split in 10 patients and partial splitting in 9 patients. In three of the eight patients who had an increase in the amount of mitral regurgitation secondary to BMV, the three-dimensional reconstructions were able to detect tears within the valve leaflet. One leaflet tear actually extended up to the mitral valve annulus and was associated with the only case of severe mitral regurgitation.Conclusions. The three-dimensional echocardiographic reconstruction enabled visualization of the mitral valve so that commissural splitting and leaflet tears not seen on the two-dimensional echocardiogram became visible.