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Abstract
PURPOSE OF REVIEW Distinction between discrete subvalvar aortic stenosis and other causes of left ventricular outflow obstruction has important implications for predicting natural history and guiding the timing and type of intervention. Imaging, primarily transthoracic echocardiography (TTE), plays a pivotal role in the diagnosis and management of adults with subvalvar aortic stenosis. RECENT FINDINGS Most systematic research on imaging of subvalvar aortic stenosis has focused on echocardiography. TTE, especially two-dimensional imaging with color and spectral Doppler, remains the main modality for delineation of the anatomic and hemodynamic features of subvalvar stenosis, associated anomalies and involvement of accessory mitral valve attachments to the subaortic septum or abnormally placed papillary muscles. Transesophageal echocardiography may provide more detailed definition of left ventricular outflow tract anatomy, including the presence and extension of the obstructive subaortic fibroelastic tissue onto the aortic or mitral valve, especially in patients with poor transthoracic windows. The clinical role for advanced imaging technologies, including three-dimensional echocardiography, cardiac magnetic resonance and computed tomography, is evolving but, largely because of the adequacy of established imaging with TTE, remains relatively limited. SUMMARY In the absence of other congenital heart defects or alternative indications (e.g. coronary angiography), TTE is usually adequate for the assessment of discrete subvalvar aortic stenosis in the adult. In specific clinical situations, supplemental imaging modalities can play an integral role in clinical decision making.
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Simpson J, Lopez L, Acar P, Friedberg MK, Khoo NS, Ko HH, Marek J, Marx G, McGhie JS, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional Echocardiography in Congenital Heart Disease: An Expert Consensus Document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2016; 30:1-27. [PMID: 27838227 DOI: 10.1016/j.echo.2016.08.022] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
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.
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Affiliation(s)
- John Simpson
- Evelina London Children's Hospital, London, United Kingdom.
| | - Leo Lopez
- Nicklaus Children's Hospital, Miami, Florida
| | | | | | - Nee S Khoo
- Stollery Children's Hospital & University of Alberta, Edmonton, Alberta, Canada
| | - H Helen Ko
- Mt. Sinai Medical Center, New York, New York
| | - Jan Marek
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gerald Marx
- Boston Children's Hospital and Harvard School of Medicine, Boston, Massachusetts
| | - Jackie S McGhie
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - David Roberson
- Advocate Children's Hospital, Chicago Medical School, Chicago, Illinois
| | | | - Owen Miller
- Evelina London Children's Hospital, London, United Kingdom
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Simpson J, Lopez L, Acar P, Friedberg M, Khoo N, Ko H, Marek J, Marx G, McGhie J, Meijboom F, Roberson D, Van den Bosch A, Miller O, Shirali G. Three-dimensional echocardiography in congenital heart disease: an expert consensus document from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1071-97. [DOI: 10.1093/ehjci/jew172] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/28/2016] [Indexed: 01/02/2023] Open
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Abstract
Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases.
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Affiliation(s)
- Takahiro Shiota
- Department of Medicine, Heart Institute, Cedars-Sinai Medical Center and University of California, Los Angeles, Los Angeles, CA, USA
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Almomani A, Modi S, Ahmad M. Real time three-dimensional transthoracic echocardiography in assessment of stented coarctation of aorta: a case-based presentation. Echocardiography 2014; 31:E310-4. [PMID: 25231011 DOI: 10.1111/echo.12734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ahmed Almomani
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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Black D, Vettukattil J. Advanced echocardiographic imaging of the congenitally malformed heart. Curr Cardiol Rev 2014; 9:241-52. [PMID: 23228075 PMCID: PMC3780349 DOI: 10.2174/1573403x11309030008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 11/24/2012] [Indexed: 11/22/2022] Open
Abstract
There have been significant advancements in the ability of echocardiography to provide both morphological and functional information in children with congenitally malformed hearts. This progress has come through the development of improved technology such as matrix array probes and software which allows for the off line analysis of images to a high standard. This article focuses on these developments and discusses some newer concepts in advanced echocardiography such is multi-planar reformatting [MPR] and tissue motion annular displacement [TMAD]. Our aim is to discuss important aspects related to the quality and reproducibility of data, to review the most recent published data regarding advanced echocardiography in the malformed heart and to guide the reader to appropriate text for overcoming the technical challenges of using these methods. Many of the technical aspects of image acquisition and post processing have been discussed in recent reviews by the authors and we would urge readers to study these texts to gain a greater understanding [1]. The quality of the two dimensional image is paramount in both strain analysis and three dimensional echocardiography. An awareness of how to improve image quality is vital to acquiring accurate and usable data. Three dimensional echocardiography (3DE) is an attempt to visualise the dynamic morphology of the heart. Although published media is the basis for theoretical knowledge of how to practically acquire images, electronic media [eg.www.3dechocardiography.com] is the only way of visualising the advantages of this technology in real time. It is important to be aware of the limitations of this technology and that much of the data gleaned from using these methods is at a research stage and not yet in regular clinical practice.
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Affiliation(s)
- D Black
- Wessex Cardiothoracic unit, Congenital Cardiac Centre, Southampton University Hospital NHS Trust, UK
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Three-dimensional echocardiography: a new paradigm shift. J Echocardiogr 2013; 12:1-11. [DOI: 10.1007/s12574-013-0189-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 07/04/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
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Subvalvular aortic stenosis diagnosed by 3D transesophageal echocardiography. J Med Ultrason (2001) 2013; 40:141-4. [PMID: 27277102 DOI: 10.1007/s10396-012-0394-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 07/21/2012] [Indexed: 10/27/2022]
Abstract
The patient was a 13-year-old male with chief complaints of exertional chest pain and dyspnea. Cardiac murmur was suspected in a medical checkup at 1 month old, at which time he was diagnosed with subvalvular aortic stenosis. He had subsequently been under follow-up observation at a nearby hospital for subvalvular aortic stenosis. He was admitted to our department for surgery due to aggravation of symptoms that had occurred over the previous year. Transthoracic echocardiography after admission showed an abnormal structure in the subvalvular aortic area, and the maximum pressure gradient between the left ventricle and aortic valve was 84 mmHg. The preoperative valve area was 0.71 cm(2), as measured by the Doppler method. Measurement of valve area by the trace method was difficult. Transesophageal echocardiography (TEE) showed a septum-like structure extending from the ventricular septum in the subvalvular area. On 3D TEE, the valve areas in the systolic and diastolic phases were 0.86 and 0.49 cm(2), respectively. Postoperative echocardiography showed resection of the structure in the subvalvular area, and the postoperative course was favorable.
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Abstract
Complex intracardiac anatomy and spatial relationships are inherent to congenital heart defects (CHDs). Recognition of the limitations of two-dimensional echocardiography has stimulated clinical interest in three-dimensional imaging. The current review examines contemporary studies in the following areas where three-dimensional echocardiography has provided additive value in CHD: (1) visualization of morphology, (2) quantitation of chamber sizes and ventricular function, and (3) image-guided interventions.
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Affiliation(s)
- Girish S Shirali
- Department of Pediatrics, Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Zhang L, Xie M, Balluz R, Ge S. Real Time Three-Dimensional Echocardiography for Evaluation of Congenital Heart Defects: State of the Art. Echocardiography 2012; 29:232-41. [DOI: 10.1111/j.1540-8175.2011.01589.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Koestenberger M, Friedberg MK, Ravekes W, Nestaas E, Hansmann G. Non-Invasive Imaging for Congenital Heart Disease: Recent Innovations in Transthoracic Echocardiography. ACTA ACUST UNITED AC 2012; Suppl 8:2. [PMID: 24163784 DOI: 10.4172/2155-9880.s8-002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Transthoracic echocardiography (TTE) is an important tool for diagnosis and follow-up of patients with congenital heart disease (CHD). Appropriate use of TTE can reduce the need for more invasive and complex modalities, such as cardiac catheterization and cardiac magnetic resonance imaging. New echocardiographic techniques have emerged for the assessment of ventricular systolic and diastolic function: Tissue Doppler imaging, tissue tracking, strain and strain rate imaging, vector velocity imaging (VVI), myocardial performance index, myocardial acceleration during isovolumic contraction (IVA), the ratio of systolic to diastolic duration (S/D ratio), and other measurements of systolic right ventricular (RV) function like tricuspid annular plane systolic excursion (TAPSE). These modalities may become valuable indicators of ventricular performance, compliance and disease progression, with the caveat of preload-dependency of the variables measured. In addition, three-dimensional (3D) echocardiography for the assessment of cardiac anatomy, valvular function, device position, ventricular volumes and ejection fraction is integrated into routine clinical care. In this review, we discuss the potential use and limitations of these new echocardiographic techniques in patients with CHD. A particular focus is on the echocardiographic assessment of right ventricular (RV) function by means of tissue Doppler imaging, tissue tracking, and three-dimensional imaging, in conditions associated with increased right ventricular volume or pressure load.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
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Bharucha T, Fernandes F, Slorach C, Mertens L, Friedberg MK. Measurement of Effective Aortic Valve Area Using Three-Dimensional Echocardiography in Children Undergoing Aortic Balloon Valvuloplasty for Aortic Stenosis. Echocardiography 2011; 29:484-91. [DOI: 10.1111/j.1540-8175.2011.01595.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lopes R, Lourenço P, Gonçalves A, Cruz C, Maciel MJ. The Natural History of Congenital Subaortic Stenosis. CONGENIT HEART DIS 2011; 6:417-23. [DOI: 10.1111/j.1747-0803.2011.00550.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dragulescu A, Mertens LL. Developments in echocardiographic techniques for the evaluation of ventricular function in children. Arch Cardiovasc Dis 2010; 103:603-14. [PMID: 21147445 DOI: 10.1016/j.acvd.2010.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 11/15/2022]
Abstract
Echocardiography is a very important tool for the diagnosis and follow-up of children with congenital and acquired heart disease. One of the challenges that remains in paediatric heart disease is the assessment of systolic and diastolic function in children, as this is influenced by growth, morphology and loading conditions. New echocardiographic techniques, such as tissue Doppler, deformation imaging and three-dimensional echocardiography, have great potential application in this field. They may provide new insights into the influence of growth, morphology and loading on cardiac mechanics, and could become useful clinical tools. In this review, we discuss the potential use and limitations of these new echocardiographic techniques in paediatric and congenital heart disease.
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Affiliation(s)
- Andreea Dragulescu
- Department of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada
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Three-Dimensional Echocardiography in Adult Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
PURPOSE OF REVIEW This study will outline recent advances in echocardiography and their impact in the understanding of cardiac morphology and ventricular function. RECENT FINDINGS Evaluation of morphologic abnormalities in pediatric cardiology has benefited greatly from three-dimensional echocardiography, particularly with the introduction of high-frequency transducers. The size of cardiovascular structures is frequently affected by heart disease, and a systematic approach to adjust measurements for the effects of body size and age has helped to distinguish a normal structure from an abnormal one. Quantification of diastolic and systolic function continues to be a major focus in echocardiography. New modalities such as tissue Doppler imaging and speckle tracking echocardiography have provided new parameters to assess myocardial performance, and these parameters include myocardial velocities, ventricular twist and torsion, strain and strain rate, and mechanical dyssynchrony. Mechanical dyssynchrony analysis has been particularly useful in cardiac resynchronization therapy, a novel treatment for heart failure which shows great promise. SUMMARY Improved delineation of cardiac morphology has greatly augmented the current understanding of congenital heart diseases, and management strategies have been modified based on three-dimensional echocardiographic findings. The introduction of new parameters to evaluate ventricular function has provided early markers for cardiovascular impairment in several disease states, thereby allowing clinicians to monitor these patients more closely.
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Abstract
PURPOSE OF REVIEW Echocardiography in pediatric and congenital heart disease is a key diagnostic technique in patients with congenital heart disease. Due to new technological developments, it has become a rapidly evolving field. RECENT FINDINGS In this review, we focus on recent developments in standardization and validation of standard techniques in pediatric and congenital echocardiography. This is mainly related to standardization of image acquisition and normalization of measurements for body size. The rest of the review is focused on the application of three-dimensional echocardiography, tissue Doppler imaging and Speqle tracking techniques to pediatric heart disease. SUMMARY New developments in standardization of echocardiography, the introduction of three-dimensional echocardiography and new functional techniques such as tissue Doppler and Speqle tracking strengthen the position of pediatric echocardiography as the most important diagnostic tool for patients with congenital heart disease.
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Scohy TV, du Plessis F, McGhie J, de Jong PL, Bogers AJ. Rapid method for intraoperative assessment of aortic coarctation using three-dimensional echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:922-5. [DOI: 10.1093/ejechocard/jep096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Beraud AS, Schnittger I, Miller DC, Liang DH. Multiplanar reconstruction of three-dimensional transthoracic echocardiography improves the presurgical assessment of mitral prolapse. J Am Soc Echocardiogr 2009; 22:907-13. [PMID: 19553082 DOI: 10.1016/j.echo.2009.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the value and accuracy of multiplanar reconstruction (MPR) of three-dimensional (3D) transthoracic echocardiographic data sets in assessing mitral valve pathology in patients with surgical mitral valve prolapse (MVP). METHODS Sixty-four patients with surgical MVP and preoperative two-dimensional (2D) and 3D transthoracic echocardiography were analyzed. The descriptions obtained by 3D MPR and 2D were compared in the context of the surgical findings. RESULTS Two-dimensional echocardiography correctly identified the prolapsing leaflets in 32 of 64 patients and 3D MPR in 46 of 64 patients (P=.016). Among the 27 patients with complex pathology (ie, more than isolated middle scallop of the posterior leaflet prolapse), 3D MPR identified 20 correctly, as opposed to 6 with 2D imaging (P<.001). CONCLUSION Interpretation of 3D transthoracic echocardiographic images with MPR improved the accuracy of the description of the MVP compared with 2D interpretation. This added value of 3D MPR was most important in extensive and/or commissural prolapse.
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Affiliation(s)
- Anne-Sophie Beraud
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, and Stanford Hospital, Stanford, California 94303, USA.
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Medrano López C, Guía Torrent JM, Rueda Núñez F, Moruno Tirado A. [Update on pediatric cardiology and congenital heart disease]. Rev Esp Cardiol 2009; 62 Suppl 1:39-52. [PMID: 19174049 DOI: 10.1016/s0300-8932(09)70040-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The fields of pediatric cardiology and congenital heart disease have experienced considerable progress in the last few years, with advances in new diagnostic and therapeutic techniques that can be applied at all stages of life from the fetus to the adult. This article reviews scientific publications in a number of areas that appeared between August 2007 and September 2008. In developed countries, congenital heart disease is becoming increasingly prevalent in nonpediatric patients, including pregnant women. Actions aimed at preventing coronary heart disease must be started early in infancy and should involve the promotion of a healthy diet and lifestyle. Recent developments in echocardiography include the introduction of three-dimensional echocardiography and of new techniques such as two-dimensional speckle tracking imaging, which can be used for both anatomical and functional investigations in patients with complex heart disease, including a univentricular heart. Progress has also occurred in fetal cardiology, with new data on prognosis and prognostic factors and developments in intrauterine interventions, though indications for these interventions have still to be established. Heart transplantation has become a routine procedure, supplemented in some cases by circulatory support devices. In catheter interventions, new devices have become available for the closure of atrial or ventricular septal defects and patent ductus arteriosus as well as for percutaneous pulmonary valve implantation. Surgery is also advancing, in some cases with hybrid techniques, particularly for the treatment of hypoplastic left heart syndrome. The article ends with a review of publications on cardiomyopathy, myocarditis and the treatment of bacterial endocarditis.
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Affiliation(s)
- Constancio Medrano López
- Cardiología Pediátrica, Hospital Infantil, Hospital General Universitario Gregorio Marañón, Madrid, España.
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Shiota T. 3D echocardiography: The present and the future. J Cardiol 2008; 52:169-85. [DOI: 10.1016/j.jjcc.2008.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 12/14/2022]
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Impact of Multiplanar Review of Three-Dimensional Echocardiographic Data on Management of Congenital Heart Disease. Ann Thorac Surg 2008; 86:875-81. [DOI: 10.1016/j.athoracsur.2008.04.106] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 04/26/2008] [Accepted: 04/29/2008] [Indexed: 11/16/2022]
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