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3D Echo - How it works

Course on cutting edge applications of 3D Echo


3D Echo represents an innovative tool for cardiovascular ultrasound that can generate added value for both the cardiologist and the cardiovascular surgeon. The usefulness of 3D echo has been proven in several applications, such as the evaluation of the anatomy of cardiac chambers; more accurate volume and mass measurements since no a priori geometric assumptions are required; assessment of LV wall motion and deformation; inspection of the valves and visualization of valvular defects and shunts by using 3D color Doppler. One limitation of 3D echo that must be overcome before its widespread use in the clinic, is the dependency of the analysis tools on specific vendors. Although similar functionalities are available on all platforms, the acquisition and analysis protocols can be significantly different.
The acquisition aspects for both 3D transthoracic and transesophageal echocardiography were elegantly addressed by the first two speakers. Mani Vannan (Columbus, US) presented how to optimally acquire a transthoracic 3D dataset. There is always a compromise to be made between the spatial and temporal resolution. The acquisition depth and sector width should be adjusted for every case in order to increase the temporal resolution whenever possible. Furthermore, if the acoustic window allows it, it is preferable to use the fundamental mode and not the harmonic mode and gain temporal resolution as a result. Acquiring a good quality RV is much more difficult than the LV; a success rate of 40% is to be expected. A split view offers the possibility to inspect the image quality during the acquisition. On some platforms, intelligent navigation possibilities are offered, and the user can adjust the view position and orientation on a 2D slice and the 3D data will be automatically cropped and aligned.
Agnes Pasquet (Brussels, BE) illustrated how to acquire a good quality 3D TEE dataset, and illustrated the advantages of real-time imaging modes (i.e. live and narrow angle acquisitions). The I-slice mode is a convenient way to present and analyze a 3D dataset.
Both authors discussed the challenges of 3D color Doppler: based on the clinical application, the color sector size has to be adjusted in order to gain temporal resolution whenever possible.
Madalina Garbi (Bromley, UK) introduced a very practical approach on how to achieve accurate global LV assessment in 3 minutes. The influence of foreshortened views and the use of inappropriate adjustment points were discussed. The added value of contrast and how it will impact the measurement was presented. Currently, the analysis tools work better for normal acquisitions than for those for which contrast is employed. In a follow-up setting, 3D echo can be used for evaluation of patients before and after CRT procedures, as well as those treated with highly toxic drugs that can have a negative impact on cardiac function.
Finally, Alain Berrebi (Paris, France) presented a comprehensive overview of valve assessment with 3D echo, which complements the standard 2D views. The choice of the acquisition protocol is dependent on the valve to be visualized. Also views that are similar to the surgical views should be generated with 3D echo. A preference for live 3D acquisition mode was indicated. Furthermore, 3D echo should be the modality of preference for assessing chordae rupture and elongation, which are much better visualized in 3D as compared to 2D. 3D echo combined with color Doppler is the modality of preference for the control of mitral repair.  


To conclude, this session gave a very practical overview of the usefulness of 3D echo in a clinical setting. Furthermore, the EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography provide an excellent literature reference for the reader interested in 3D echo.




3D Echo - How it works

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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