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Non-invasive imaging
Real-time three dimensional echocardiography: current and future clinical applications
  1. Nina Ajmone Marsan1,
  2. Laurens F Tops1,
  3. Petros Nihoyannopoulos2,
  4. Eduard R Holman1,
  5. Jeroen J Bax1
  1. 1
    Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2
    Department of Cardiology, Imperial College of Medicine and Technology, Hammersmith Hospital, London, UK
  1. Correspondence to Professor Jeroen J Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; j.j.bax{at}

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Conventional echocardiography is the most commonly used imaging technique in clinical cardiology. However, the complex cardiac anatomy and the sophisticated functional mechanisms of the cardiac structures require a transition from a two dimensional (2D) to a three dimensional (3D) approach. In fact, conventional 2D echocardiography makes significant geometric assumptions for the quantification of cardiac size, and only permits cross-sectional views for interpretation of cardiac pathologies. Real-time 3D echocardiography (RT3DE) may overcome most of these limitations and is now readily available as a clinically applicable imaging technique.w1

Early approaches to 3D echocardiography were based on off-line and time consuming reconstructions of a series of 2D images obtained by either freehand scanning or a mechanically driven rotating transducer.w2 Current generation 3D echo transducers consist of a fully sampled matrix array of more than 3000 simultaneously active ultrasound elements that provide real-time volumetric scanning with rapid post-processing. Recently, this novel technology has also been applied to a new generation of transoesophageal probes, broadening the possibility of clinical applications.w3 w4

The main advantages of a 3D echocardiographic approach are summarised in table 1. In this article, the role of RT3DE for the assessment of cardiac chambers size and function and for the evaluation of valvular and congenital heart diseases will be reviewed. In addition, the potential future applications of RT3DE will be discussed.

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Table 1

Current clinical applications of real-time three dimensional echocardiography (RT3DE) and its advantages over conventional two dimensional (2D) echocardiography

Assessment of left ventricular size and function

The most common indication for performing an echocardiogram in adult patients is the assessment of left ventricular (LV) size and function. Diagnostic clues, prognostic implications, and important therapeutic decisions rest upon the results of this evaluation that consequently needs to be as accurate and reproducible as possible.

Quantification of left ventricular volumes

The conventional 2D quantification of LV volumes is based on the biplane …

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  • Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. JJ Bax has research grants from Medtronic, Boston Scientific, BMS medical imaging, St Jude Medical, GE Healthcare, and Edwards Lifesciences.

  • Provenance and peer review Commissioned; not externally peer reviewed.

  • ▸ Additional references are published online only at