Original ArticlesThree-dimensional echocardiography: clinical relevance and application
Section snippets
Methods
There are different methods of acquiring data for 3D echocardiography in a sequential manner along or around an axis, or using reference views. Briefly, “random” acquisition implies data collection performed in a random order, with position and orientation of the transducer recorded and updated by a sensing device such as mechanical arms or magnetic or acoustic sensors. An image in one orientation functioning as reference allows alignment of images in other planes. Studies utilizing these
Quantitative approach
Two-dimensional echocardiography is a widely used diagnostic tool in the assessement of cardiovascular disorders. Unfortunately, it has some limitations due to reproducing 3D structures such as the heart and great vessels into only two dimensions. Derivation of quantitative data from 2D echocardiography requires geometric assumptions that may be reasonable in the presence of a normal left ventricular shape, but not reliable when cardiac chambers are distorted.
An important aspect of 3D
Valvular heart disease
The degree of stenosis (valve area) and morphologic and functional alterations in regurgitant valves can be assessed quantitatively.
Congenital heart diseases
Several studies with 3D echocardiography have demonstrated the potential capacity of this technique to better evaluate congenital cardiac disorders.19, 20, 21, 22 In patients with atrial septal defects (Figure 6 ), site and size of the defect can be visualized “en face” from the left and right side.23, 24 Diameters of the defect can be measured directly from the 3D image. Information on the size of the limbus of the defect can be obtained to evaluate the distances of the other nearby structures
Cardiac masses
One of the obvious advantages of 3D echocardiography is that it can provide a better comprehension of cardiac abnormalities such as intracardiac masses and tumors. The precise site of attachment of the mass, its shape, and its size are evaluated more clearly by 3D echocardiography.25 Left atrial thrombi (Figure 7 ), intracardiac tumors such as myxoma, and vegetations have been studied in the clinical setting. Based on in vitro validation, these masses have also been quantitatively assessed and
Ischemic heart disease
Two-dimensional echocardiography has proven to be an extremely useful tool in the diagnosis of ischemic heart disease. It provides important prognostic data in patients with acute or chronic coronary artery disease. However, the ability to detect wall motion abnormalities is limited by the use of few selected nonparallel views extrapolated from the whole left ventricle. This implies an incomplete appreciation of the spatial relations between cardiac structures and the use of geometric
Intracardiac blood flow jets
A recent development in 3D echocardiography is the reconstruction of Doppler color flow jets. It is possible to reconstruct flow in 3 dimensions and demonstrate the presence of multiple discrete regurgitant jets across the mitral valve (Figure 8). Investigators from our institution29 evaluated a group of patients with mitral regurgitation in a series of 41 patients with various valvular abnormalities using voxel-based 3D reconstruction of color flow jets. We demonstrated the presence of
Future directions
Every facet of 3D echocardiography is in continuous expansion. Integrating software into the echo machine could allow easier and faster acquisition of 2D images. The operator does not need to apply a motor device on the probe or to connect the computer system to the ultrasound system. This facilitates the acquisition phase, important to obtaining a high quality 3D image. Again, it is more confortable, especially in operating room, to transfer the acquired data into an optical disk without
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