Real-time transthoracic three-dimensional echocardiography provides additional information of left-sided AV valve morphology after AVSD repair

Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography

Three-dimensional echocardiography (3DE) has become important in the management of patients with congenital heart disease (CHD), particularly with pre-surgical planning, guidance of catheter intervention, and functional assessment of the heart. 3DE is increasingly used in children because of good acoustic windows and the non-invasive nature of the technique. The aim of this paper is to provide a review of the optimal application of 3DE in CHD including technical considerations, image orientation, application to different lesions, procedural guidance, and functional assessment.

3D echocardiography in congenital heart disease: a valuable tool for the surgeon

Real-time 3D echocardiography has been used increasingly in the assessment of patients with congenital heart disease. A number of studies have confirmed that this modality can be used as a complementary method to delineate morphology and spatial relationships of simple and more complex congenital heart lesions during surgical planning. Communication between the echocardiographer and surgeon can be simplified as simulation of surgical views can be achieved, thus minimizing the potential for error related to mental reconstruction. This review summarizes the available evidence for the role of real-time 3D echocardiography in congenital heart disease as an imaging modality to assist surgeons.

Usefulness of the multiplanar reformatting mode of three-dimensional echocardiography in evaluating valvular and structural heart disease: An experience from Saudi Arabia

OBJECTIVE

The aim of this study is to compare the feasibility and capacity of multiplanar reformatting (MPR) mode of three-dimensional echocardiography (3DE-MPR technique) with two-dimensional echocardiography (2DE) for visualizing morphological details during evaluation of congenital heart disease (CHD). The study also seeks to validate the accuracy of 3DE MPR in determining cardiac valvular lesions and the application of the 3DE-MPR technique in daily clinical practice.

METHODS

A cross-sectional study was carried out at Madinah Cardiac Centre, Saudi Arabia from May to December 2012. Various forms of CHD were diagnosed in 43 patients by conventional 2DE, and the patients were then examined with the 3DE-MPR technique using dedicated software and a standard protocol.

RESULTS

Of the 43 patients, 23 (53.5%) were males and 20 (46.5%) females. Their age varied from 30 days to 146 months (mean age, 70.2 months and SD = 42.5 months) and their weight from 4 to 42 kg (mean weight, 20.2 kg and SD = 9.7 kg). The 2DE showed left heart lesions in nine patients (20.9%), right heart lesions in 23 (53.5%), atrial septal defects in five (11.6%) and complex CHD in six patients (14%). The 3DE MPR technique application and analysis was possible in all patients. The study demonstrated the fields where 3DE MPR was of additive value to conventional 2DE for the vena contracta area in valvular regurgitation severity and the planimetry for the valvular stenosis precise estimation, enface views of atrial septal defects with direct visualisation of shape and size of the defect, and segmental analysis of complex CHD using one window. The clinician and surgeon were then able to determine the mechanism and severity of the lesions and thus decide on appropriate treatment and management.

CONCLUSION

The study demonstrated the usefulness of 3DE-MPR as a complement to conventional 2DE. The technique is a significant technological breakthrough that allows instant visualization of morphological details and precise determination of cardiac valvular lesions, which were less clearly delineated by 2DE alone.

Feasibility and effectiveness of three-dimensional echocardiography in diagnosing congenital heart diseases

Three-dimensional echocardiography (3DE), a novel approach employed in detecting congenital heart disease (CHD), has gained popularity since it was made commercially available in 2002. This modality is now accepted as an important diagnostic tool for diagnosing CHD. Advancement in transducer technologies and digital data processing allows the use of 3DE in daily clinical practice. In this review, modes of 3DE data acquisition and storage methods in the echocardiogram's machine's hard disk (data processing) are examined. Analysis of the acquired data (cropping or slicing the data set) and methods of illustrating the cropped data set for cardiologists and pediatric cardiovascular surgeons are also discussed. Published literature was searched in PubMed using the keywords "three-dimensional echocardiography", "congenital heart disease", "cropping", and "echoangiogram". This search produced 100 articles, which were further short-listed to 30 articles. Based on this algorithm, the final selected 30 articles were extensively examined in the current review. The clinical applications of real-time transthoracic 3DE, as well as novel transesophageal 3DE and color flow 3DE data set analyses (echoangiogram) in the routine practice of CHD assessment, are also reviewed. Finally, the limitations 3DE, together with the potential future developments required to improve various techniques of 3DE to make it more readily applicable, are examined.

Considerations for laboratory animal imaging center design and setup

In vivo animal imaging is an outstanding noninvasive tool to study the pathophysiology of disease or response to therapy; additionally, serial imaging reduces the required number of experimental animals. Because of the tremendous capital investment, we recommend the imaging center be a shared resource to facilitate innovative and productive cross-disciplinary scientific collaborations. A shared center also enables a broader range of imaging, as equipment is often cost prohibitive for smaller facilities. A multitude of factors will determine the architectural design, facility efficiency, and functionality. Important considerations to determine during the planning stages include the types of animals to be imaged, types of imaging studies to be performed, types of imaging equipment and related services to be offered, and the location of the imaging center. Architects must work closely with manufacturers to accommodate equipment-related building specifications; facility planners and veterinarians can provide a practical logistical design that will ensure efficient functionality. Miscellaneous considerations include biosecurity levels, use of radioisotopes, and personnel safety in the imaging environment. The ideal imaging center will include space to house animals and perform necessary preimaging procedures, state-of-the-art in vivo imaging devices and the most up-to-date anesthesia, physiological support, and monitoring equipment. The center staff should include imaging specialists for technical development and data analysis. As it is difficult to provide a comprehensive manual for setting up an in vivo animal imaging center, we offer advice based on our experiences with the National Institutes of Health Mouse Imaging Facility. Because magnetic resonance imaging (MRI) is the most expensive imaging tool, requires specific building design considerations, and poses unique occupational health and safety risks, we focus on MRI as the foundation for an imaging facility design.

What is new in pediatric cardiac imaging?

Cardiac imaging has had significant influence on the science and practice of pediatric cardiology. Especially the development and improvements made in non-invasive imaging techniques, like echocardiography and cardiac magnetic resonance imaging (MRI), have been extremely important. Technical advancements in the field of medical imaging are quickly being made. This review will focus on some of the important evolutions in pediatric cardiac imaging. Techniques such as intracardiac echocardiography, 3D echocardiography, and tissue Doppler imaging are relatively new echocardiographic techniques, which further optimize the anatomical and functional aspects of congenital heart disease. Also, the current standing of cardiac MRI and cardiac computerized tomography will be discussed. Finally, the recent European efforts to organize training and accreditation in pediatric echocardiography are highlighted.

Appearance of noncompaction‐like remodeling of the anatomical right ventricle in a middle‐aged subject with modified transposition of the great arteries who did not undergo surgery

We describe noncompaction-like remodeling of the anatomical right ventricle (ARV) in a middle-aged subject with modified transposition of the great arteries (TGA). A 54 year-old male had been diagnosed with modified TGA at age 40, but no surgery was performed. Enhanced multislice CT revealed the ascending aorta coursing left of the anterior pulmonary trunk. Furthermore, the myocardium of the ARV appeared thickened, but contrast material could be observed in the ARV myocardium, which resembled noncompaction of the left ventricle (LV). We speculated trabecular development of the ARV, such as a Chiari network, and with TGA, the ARV provided systemic circulation through the aorta. The ARV wall may have thickened due to systemic pressure load, resulting in reduction of wall motion of the ARV on transthoracic echocardiogram. Recent advances in multislice CT imaging have revolutionized the exploration of RV anatomy, especially for depicting the three-dimensional appearance of noncompaction-like remodeling of the ARV in modified TGA in addition to transposition of the great arteries.

Real‐time three‐dimensional echocardiography provides novel and useful anatomic insights of perimembranous ventricular septal aneurysm

BACKGROUND

Real-time three-dimensional echocardiography (RT3DE) is a new image modality, and it can display a unique image reconstruction in a variety of heart diseases. However, clinical assessment of ventricular septal aneurysm (VSA) by RT3DE has not been reported. This pilot prospective study is to survey what kinds of new insights of VSA can be provided by RT3DE as compared with conventional 2-dimensional echocardiography (2DE).

METHODS

We investigated the diagnostic value of RT3DE and 2DE in 60 consecutive patients with VSA. From different transthoracic windows, structures of interest can be displayed from any orientation through adjusting cropping and slicing the RT3DE datasets. The results were compared with those in 2DE.

RESULTS

RT3DE reconstruction of VSA was feasible in 56 of 60 patients (93%). When compared with 2DE, additional information provided by RT3DE included blood flow through left ventricle to right ventricle, visualization of VSD enface border in 56 patients (93%), morphology of the VSA from apical short axis view in 48 patients (86%), hypertrophied margin of the interventricular septum in 26 patients (43%), dynamic changes of VSA and tricuspid valve in 18 patients (30%), adhesion of chordae tendineae in VSA in 16 patients (26%).

CONCLUSIONS

Structures of interest can be evaluated from unique RT3DE in any orientation during scanning. RT3DE offers additional novel views and has the advantages of not only displaying better visualization of VSA, but also adequately showing the spatial relationship with its adjacent structures. It can provide novel and useful anatomic insights than 2DE while assessing patients with VSA.

Three-Dimensional Echocardiography in Congenital Heart Disease

Matrix array technology has brought three-dimensional echocardiography into the clinical practice of cardiology. Arguably, this advancement is most notable in the field of pediatric cardiology. Full-volume acquisitions now can be undertaken in the youngest of infants with excellent image quality. This article illustrates the clinical application of three-dimensional echocardiography in congenital heart disease.

Three-dimensional Echocardiography Improves the Understanding of the Mechanisms and Site of Left Atrioventricular Valve Regurgitation in Atrioventricular Septal Defect

OBJECTIVES

The purpose of this study was to determine whether 3-dimensional echocardiography (3DE) provides additional information regarding the mechanisms and sites of left atrioventricular valve regurgitation in atrioventricular septal defect compared with transesophageal 2-dimensional echocardiography (2DE).

METHODS

Eleven patients with a median age of 5.4 years (2.9-11.6 years) and a median weight of 16.8 kg (13.7-38.3 kg) with an atrioventricular septal defect underwent simultaneous transesophageal 2DE and 3DE before operation.

RESULTS

The 2DE-3DE agreement for the assessment of the superior and mural leaflet size was 72.7%. The 2DE-3DE agreement for coaptation failure, a residual or primary cleft, and commissural abnormalities as a mechanism of regurgitation were 72.7%, 63.6%, and 36.4%, respectively. For jet sites the 2DE-3DE agreement was 63.6% for a commissural and central location.

CONCLUSION

Three-dimensional echocardiography provides new and superior data regarding the mechanisms and sites of left atrioventricular valve regurgitation in atrioventricular septal defect.