Three-dimensional echocardiography: clinical relevance and application

doi:10.1016/S0002-9149(98)00063-0

The American Journal of Cardiology

Volume 81, Issue 12, Supplement 1, 18 June 1998, Pages 96G-102G

https://doi.org/10.1016/S0002-9149(98)00063-0 Get rights and content

Abstract

Three-dimensional (3D) echocardiography has recently become a practical reality. It is now practicable to perform 3D echocardiography using transthoracic and transesophageal acoustic windows both in adults and children. The unique image projections that 3D echocardiography yields appear to have enormous potential for displaying intracardiac anatomy in exquisite detail. An important aspect of 3D echocardiography is its ability to supply accurate quantitative data without the use of geometric assumptions. In particular, coupled to contrast ultrasound agents, 3D echocardiography could be valuable in the assessment of myocardial perfusion abnormalities. Early clinical experience suggests that 3D echocardiography is likely to play a valuable role in the evaluation of various cardiac disorders, especially in cardiac surgery. In this section, we will review the use of volume-rendered 3D echocardiography in the diagnosis and assessment of cardiac disorders with particular emphasis on the clinical application of this new methodology.

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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Cited by (33)

Threedimensional imaging of carotid arteries: Advantages and pitfalls of ultrasound investigations
2012, Perspectives in Medicine
Citation Excerpt :
Several specialists use three-dimensional (3D) ultrasound (US) as adjuvant imaging technique in their clinical practice, from cardiologists to gynecologists [1–5].
To describe normal and pathological findings with three-dimensional (3D) ultrasound of the carotid bifurcation.
Patients admitted to our ultrasound laboratory for vascular screening were submitted to standard carotid duplex and to 3D ultrasound reconstruction of the carotid bifurcation. Volume 3D scans were performed manually, on the axial plane, and the software presented the volume rendering from the inward blood flow signal detected with the Power Color Mode.
Forty normal subjects, 7 patients with caliber alterations (4 carotid bulb ectasia and 3 internal carotid lumen narrowing), 45 patients with course variations (tortuosities and kinkings) and 35 patients with internal carotid artery stenosis of various degrees have been investigated.
3D ultrasound is a feasible technique. It can improve carotid axis general imaging through a global image presentation “at a glance”, visualizing caliber variations and vessels course. Imaging of stenosis from inward flow can be provided, but complete stenosis characterization requires the assessment of plaque morphology and vessel wall.
Three-Dimensional echo: Transition from theory to real-time, A technology now ready for prime time
2005, Current Problems in Diagnostic Radiology
Use of novel nonfluoroscopic three-dimensional electroanatomic mapping system to monitor and analyze heart surgery in animal models
2004, Chest
Citation Excerpt :
Figure 4 includes all data describing each point movement during a normal systole and the local movements in different parts of the heart as a result of contraction of the skeletal muscle around the left ventricle. Echocardiography is capable of generating 3D geometric information of the heart, and the improvements in 3D as compared to two-dimensional echocardiography are important in this respect.1718 However, although several methods were developed to facilitate automatic border detection, the main drawback of echocardiography for experimental use is the subjective bias of the device operator and the interpreter of the echocardiography data.19202122
The new method of three-dimensional (3D) electroanatomic mapping was presented as an important tool for cardiac imaging and intervention. We present herein the first use of this technology for the monitoring, analysis, and development of cardiac surgery at the preclinical stage.
The method is based on utilizing a locatable catheter connected to an endocardial mapping and navigating system, to accurately establish the location and orientation of the tip of the mapping catheter and simultaneously record its local electrogram. The 3D geometry of the beating cardiac chamber is reconstructed in real time. The system was tested on six goats that underwent dynamic cardiomyoplasty. Two maps of each animal were performed: preoperative and postoperative during the stimulation protocol of the skeletal muscle.
The electroanatomic mapping system provided detailed maps of the left ventricle during the stimulation protocol, which demonstrated a striking geometric difference between the assisted and the unassisted beats. These geometric changes are best described by referring to left ventricular long-axis movements (22.3 ± 3.8° vs 3.4 ± 1.6°, p < 0.001), center-of-mass movements (10.4 ± 3.0 mm vs 3.9 ± 1.6 mm, p < 0.005), and the changes in upward movement viewed along the base (7.9 ± 1.9 mm vs 3.6 ± 1.7 mm, p < 0.01), middle (13.8 ± 4.0 mm vs 7.3 ± 1.8 mm, p < 0.005), and the apex of the heart (28.1 ± 4.5 vs 5.3 ± 2.3 mm, p < 0.001) [mean ± SD].
The 3D electroanatomic mapping system allows detailed reconstruction of the left ventricular geometry and a clear view of the difference between the assisted and the unassisted beats. This novel monitoring system may serve as an important tool for the analysis and development of new techniques in cardiac surgery.
Anatomic validation of a novel method for left ventricular volume and mass measurements with use of real-time 3-dimensional echocardiography
2001, Journal of the American Society of Echocardiography
Assessment of left ventricular (LV) volumes and mass is a critical element in the evaluation of patients with cardiovascular disease. However, most non-invasive methods used for the quantitative measurements of LV volume and mass have important intrinsic limitations. Real-time 3-dimensional echocardiography (RT3D echo) is a new technique capable of acquiring volumetric images without cardiac or respiratory gating. The purpose of this study was to develop and validate a system for rapid LV volume and mass measurements with the use of RT3D echo images. To this end, in 11 explanted sheep hearts, the left ventricle was instrumented with a latex balloon and filled with known volumes of saline solution. Two independent observers made volume calculations from images acquired with RT3D echo. In addition, 21 open-chest sheep were imaged with RT3D echo for LV mass calculation. Anatomic LV mass was determined after removing the heart. A strong correlation was observed between the actual LV volumes and those calculated from the RT3D echo images (r = 0.99; y = 1.31 + 0.98x; standard error of the estimate = 2.2 mL). An analysis of intraobserver and interobserver variabilities revealed high indexes of agreement. A strong correlation was observed between actual LV mass and that calculated from RT3D echo images (r = 0.94; y = 14.4 + 0.89x; standard error of the estimate = 8.5 gm). Thus RT3D echo images allow rapid and accurate measurements of LV volume and mass. This technique may expand the use of cardiac ultrasonography for the quantitative assessment of heart disease.
Evaluation of left ventricular systolic function by 3D echocardiography: A comparative study with X-ray angiography and radionuclide angiography
2000, European Journal of Ultrasound
Objective: the aim of this study was to evaluate left ventricular systolic function by 3D ultrasound as compared to with radionuclide and X-ray angiographies. Methods: one hundred and four patients were examinated by 3D ultrasound (3D-US) but only 72 examinations were successful. Thirty patients were investigated by 3D-US, M-mode US or bidimensional (2D) US, and X-ray angiography (group I) and 42 patients were investigated by 3D-US, M-mode, or 2D, and radionuclide angiography (group II). Results: the correlation between ejection fraction (EF) evaluated by 3D-US and reference methods was found to be good and similar for the two groups (r=0.75; P<10⁻⁴ for group I and r=0.76; P<10⁻⁴ for group II). The correlation between EF calculated by conventional 2D-US and by reference methods was lower (r=0.60; P=0.04 for group I and r=0.54; P=0.001 for group II). The correlation between EF evaluated by 3D- and 2D-US was modest (r=0.55; P=0.001 for the whole group). The correlation between 3D-US left ventricle end-diastolic volume (EDV) and end-systolic volume (ESV) and those evaluated by X-ray angiography was also modest (r=0.33; NS for EDV and r=0.60; P<10⁻⁴ for ESV). The correlations between EDV and ESV in 3D-US, and those evaluated from radionuclide angiography were fairly good and in the same range (r=0.76; P<10⁻⁴ and r=0.87; P<10⁻⁴). Conclusion: the 3D-US system using a rotating probe in an apical view is valuable for evaluation of left ventricular systolic function.
Three-dimensional transesophageal echocardiography (TEE) and other future directions
2000, Cardiology Clinics
Citation Excerpt :
Latest methods using digitally acquired color Doppler images may provide new possibilities of looking at flow abnormalities. As with two-dimensional imaging, three-dimensional echocardiography is opening up new horizons in cardiac imaging.26,32 It has found a role not only in general cardiology and echocardiographic laboratories but also in other clinical settings, such as the operating room, the intensive care unit, and the emergency department.
Transesophageal echocardiography (TEE) first came onto the scene in the early 1970s.31, 91, 95 As a diagnostic modality, it was a new method that allowed the heart to be viewed with better image quality than conventional transthoracic echocardiography. For the first time, the images obtained could be viewed with less attenuation because of shadowing from structures, such as the lung, bone, and soft tissue. The facility to perform Doppler presented the clinician with the ability to functionally assess the hemodynamics and flow disorders in greater detail.³¹ As much as this advance changed the face of echocardiography, it is still essentially a two-dimensional mode of imaging and is limited in portraying the three-dimensional human heart anatomically. Every facet of the heart, its pathology, and function are three-dimensional in nature. Two-dimensional echocardiography is limited in providing a clear uninhibited look at the heart in all views. It was left to the examiner to mentally form a three-dimensional picture of the heart from all the data obtained from the two-dimensional images. A method was needed that could visualize the heart in a three-dimensional format.
An attempt to develop three-dimensional imaging was first undertaken in the early 1970s.29, 69 In its infancy, three-dimensional echocardiography was used mainly to measure left ventricular volumes using manual tracing methods from multiple cross-sectional images.3, 63 Three-dimensional echocardiography was laborious and time-consuming initially, but soon it was realized that the potential of three-dimensional echocardiography was an opportunity waiting to be harnessed.49, 81, 85 Although three-dimensional echocardiography can be performed by way of transthoracic and transesophageal methods, the improved image resolution obtained from TEE makes it much more useful for three-dimensional image reconstruction, the quality of which is dependent on the raw two-dimensional images.¹¹ Today, three-dimensional TEE is emerging as an extremely useful imaging tool with a multitude of clinical applications.82, 94, 101, 104, 105, 109

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Original ArticlesThree-dimensional echocardiography: clinical relevance and application

Abstract

Section snippets

Methods

Quantitative approach

Valvular heart disease

Congenital heart diseases

Cardiac masses

Ischemic heart disease

Intracardiac blood flow jets

Future directions

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

Am J Cardiol

Am J Cardiol

Three-dimensional spatial registration and interactive display of position and orientation of real time ultrasound images

Ultrasound Med

Three-dimensional echocardiographyin vivo validation for left ventricular volume and function

Circulation

A new integrated system for three-dimensional echocardiographic reconstructiondevelopment and validation for ventricular volume with application in human subjects

J Am Coll Cardiol

Three-dimensional echocardiographic reconstruction of the mitral valve, with implication for the diagnosis of mitral valve prolapse

Circulation

Three-dimensional and four-dimensional transesophageal echocardiographic imaging of the heart and aorta in humans using a computed tomographic imaging probe

Echocardiography

Dynamic three-dimensional echocardiographyMethods and clinical potential

Echocardiography

Original Articles
Three-dimensional echocardiography: clinical relevance and application