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Congenital heart disease
Three dimensional echocardiography in congenital heart disease
  1. Joseph John Vettukattil
  1. Correspondence to Dr Joseph John Vettukattil, Paediatric Cardiology, Wessex Cardiac Centre, Southampton University Hospital NHS Trust, Southampton, SO16 6YD, UK; joseph.vettukattil{at}suht.swest.nhs.uk

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Ultrasound imaging of the human heart has undergone revolutionary changes along with recent strides in computing power. Since the wider acceptance of two dimensional (2D) echocardiography in the 1970s, progress in this field had slowed to some extent. However, the quest for three dimensional (3D) ultrasound imaging of the heart began in the early 1960s when Baum and Greenwood introduced the concept by imaging the orbit using a series of parallel slices.w1 It was not until 1974, when Dekker and colleagues sought to construct a 3D model of the heart using a mechanical spatial locator,1 that the concept became more realistic. Their model was limited to an open chest with fixed point imaging, requiring all the desired images to be obtained from one location—an extremely slow and primitive process suitable only for research.

In 1986 Martin and colleaguesw2 used a micromanipulator controlled transoesophageal transducer which marked the beginning of 3D transoesophageal echocardiography (3DTOE). In 1991, Kuroda et al2 described a 3D system that rotated the TOE probe, and simultaneously Woolschlager et alw3 described a TOE system that was able to take serial slices. Further development of a rotating array like a propeller or a fan, parallel to the imaging plane, overcame the problem of the small ultrasound window. In 1989, Raqueno reconstructed the conventional 2D colour flow Doppler images into 3D volumes. TomTec (Unterschleissheim, Germany) converted colour velocity data through a post-processor to assign different colours and used a transparency slider to give the appearance of ‘see through’ jets.

In 1990, Von Ramm and Smithw4 from Duke University used a real-time volumetric 3D system with a matrix array probe. This utilised parallel processing to obtain pyramidal volume which displayed multiple image planes. In this model 2D arrays steered the sound over an entire pyramidal …

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