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Three dimensional echocardiography for the assessment of mitral valve disease
  1. N Sutariaa,
  2. D Northridgea,
  3. N Masanib,
  4. N Pandianc
  1. aDepartment of Cardiology, Western General Hospital, Edinburgh, UK, bDepartment of Cardiology, University Hospital of Wales, Cardiff, UK, cDepartment of Cardiology, New England Medical Centre, Boston, USA
  1. Dr N Sutaria, Reseach Fellow in Cardiology, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UKN.Sutaria{at}

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Whereas conventional two dimensional (2D) echocardiography is crucial to our understanding of the complex anatomy and three dimensional (3D) spacial relationships of cardiac structures, it requires the mental integration of a limited number of 2D imaging planes. This mental 3D reconstruction is inherently variable according to observer experience and expertise, and can only be described to other clinicians (such as surgeons) rather than displayed reproducibly. The display of cardiac anatomy in three dimensions from any perspective would have clear advantages over conventional 2D imaging and provide an insight into the functional and anatomic properties of cardiac structures. Recent advances in ultrasound and computer technology have been combined such that dynamic 3D echocardiographic imaging is now a practical reality.

Three dimensional echocardiography (3DE) has been shown to be more accurate than 2DE in the quantification of cardiac volumes.1 2 These studies used either manually contoured, static “wire frame” reconstructions or dynamic “volumetric” automated reconstruction technology that is now commercially available—we concentrate on the latter methodology in this review. The benefits of 3DE are particularly well suited to the study of the mitral valve given its complex morphology and the importance of delineating its anatomy precisely in various pathological states. This was shown by Levine et al who used wire frame reconstruction of the mitral valve to define the 3D morphology of the mitral annulus and its relationship to mitral leaflet position, thereby clarifying the echocardiographic definition of mitral valve prolapse.3 The assessment of patients with mitral valve disease is one of the most promising clinical applications of this technology.

Dataset acquisition, processing and reconstruction

A 3D dataset is composed of anatomical information from multiple 2D cross sectional images. For reconstruction of the mitral valve in adult patients, transoesophageal echocardiography (TOE) is the preferred approach for 2D image acquisition as it offers a relatively stable …

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