Original articleReal-Time Transthoracic Three-Dimensional Echocardiographic Assessment of Left Ventricular Volume and Ejection Fraction in Congenital Heart Disease
Section snippets
Study Population
Thirty-two consecutive patients (59% were male) who were scheduled for routine MRI examination were included in the study. The mean age was 31 ± 9 years (range 19-51 years). All patients had distorted LV geometry that originated from the congenital heart malformation itself and was the result of a dilated or high-pressured right ventricle. In 13 patients with surgically corrected tetralogy of Fallot, LV geometry was abnormal throughout the cardiac cycle because of flattening of the
Results
Acquisition of RT-3DE data sets was feasible in 29 of the 32 patients (91%). One patient had poor acoustic windows because of severe obesity, and two patients had persistent respiratory artifacts that precluded adequate 3D rendering. MRI was feasible in 29 patients; three patients (not the same patients in which RT-3DE was not successful) had claustrophobia or artifacts that prohibited complete analysis. The mean heart rate was 68 ± 8 beats/min during echocardiographic examination and 66 ± 9
Discussion
The results of this study indicate that RT-3DE data acquisition of the abnormally shaped LV for volumetric analysis is feasible in patients with CHD. There is a good agreement between RT-3DE using manual border tracing and MRI for the assessment of LV volume and function. Furthermore, the intraobserver and interobserver variabilities were limited. This implies that this technique is largely operator-independent and can be used in clinical practice.
Until now, 3D echocardiography was hampered by
Study limitations
To acquire a full-volume data set, four high-resolution subvolumes need to be acquired over consecutive heartbeats in a short breath-hold. Patients with arrhythmia or severe dyspnea, who are incapable of breath-holding, cannot be investigated using this technique. However, this also applies for MRI.
The RT-3DE system has a limited angle for full volume acquisition; this may cause inaccurate measurements of LV volume when the entire LV cannot be included in the pyramidal volume.
This study was
Conclusion
RT-3DE is feasible in adult patients with CHD for volumetric analysis of the abnormal LV and allows accurate determination of its volume and EF compared with MRI. RT-3DE may potentially provide convenient, mobile, and comprehensive evaluation of LV function in patients with CHD.
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Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography
2017, Journal of the American Society of EchocardiographyCitation Excerpt :Vendors typically display reference planes used to define the endocardial border (Figure 15) as well as the ‘shell’ of the LV itself (Figure 16). Current tracking algorithms involve user definition of key reference points followed by semi-automated tracking of the endocardium, but the operator can manually override the initial automated selection of the endocardial border.122 Despite difficult endocardial delineation and heterogeneous LV shapes, accurate determination of LV volume and function by 3DE has been reported in adults and children with CHD using MRI as the gold standard.
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