Atlas of Three-dimensional Echocardiography

An electronic book containing a large collection of 3D echocardiographic images and videos to help echocardiographers, cardiac surgeons and clinical cardiologists.

Updated version 2012

Luigi P. Badano and Denisa Muraru
Department of cardiac, thoracic and vascular sciences
University of Padua, School of Medicine
Padua (Italy)

Presentation

Three-dimensional echocardiography (3DE) enables an easier, accurate and reproducible interpretation of the complex cardiac anatomy, overcoming the intrinsic limitations of conventional echocardiography. The availability of unprecedented views of cardiac structures from any perspective in the beating heart provides valuable clinical information and new levels of confidence in diagnosing heart disease. One major advantage of 3DE is the improvement in the accuracy and reproducibility of chamber volume measurement by eliminating geometric assumptions and errors caused by foreshortened views. Another benefit of 3DE is the realistic en face views of heart valves, enabling a better appreciation of the severity and mechanisms of valve diseases in a unique, noninvasive manner.

In previous years, the Atlas of real-time three-dimensional echocardiography has been one of the most visited sections of the website of the European Association of Echocardiography. Since its launch in December 2008, it has been visited by 4546 unique visitors for a total number of 13656 pages visited witnessing the interest of EAE members for this new echo technique.

Since 2009, three-dimensional echocardiography has experienced significant technological improvement and the technique has been implemented in the most advanced echo labs and cardiac surgery operating rooms to provide crucial morphological and quantitative information to improve patient management.

However, the technique is still not widespread. One of the reasons of this lack of wide clinical acceptance is that the proper and effective use of this new way to look at cardiac anatomy and function using ultrasounds requires an appropriate training. The first edition of the Atlas was to help echocardiographers and cardiac surgeons, but also clinical cardiologists, to understand the basic principles of 3DE and interpret 3DE images.

In this completely new version of the Atlas, we present the current 3DE techniques, the examination protocols for a comprehensive 3DE study and the clinical applications of the technique. All these topics will be addressed by few introductory sentences and illustrated by 395 movies, 160 figures, 14 drawings and anatomic specimens, obtained from more than 250 original clinical cases of acquired and congenital heart diseases..

Luigi P. Badano and Denisa Muraru

The content of the Atlas of Three-dimensional Echocardiography

Background

• Reconstruction Methods
• Real-time 3D Acquisition

Acquisition Methods

• Acquisition Methods

Technical Factors

• Technical Factors

Image Display

• Image Display
• Examination Protocol

Left Ventricle

• Volumes and Ejection Fraction
• Shape (sphericity index)
• Mass
• Myocardial deformation (strain)
• Regional Wall Motion
• Intraventricular Synchronicity
• Size, Shape and Function
• Masses
• Left Ventricular Noncompaction
• Amyloidosis
• Apical Hypertrophic Cardiomyopathy
• Take Home Messages

Mitral Valve

• Normal Mitral Valve
• Mitral Stenosis
• Mitral Valve Prolapse
• Mitral Valve Annulus
• Congenital Abnormalities
• Functional Mitral Regurgitation
• Severity of Mitral Regurgitation
• Acute Mitral Regurgitation (Papillary Muscle Rupture)
• Mitral Valve Repair (Alfieri’s Procedure)
• Valve Prostheses
• Paraprosthetic Leakage
• Prosthetic Mitral Annulus Detachment
• Prosthetic Valve Thrombosis
• Prosthetic Valve Endocarditis
• Valve-in-Valve Procedure
• Take Home Messages

Aortic Valve

• Normal Aortic Valve
• Acquisition
• 3D Transoesophageal Echocardiography
• Aortic Valve Complex
• Mitro-Aortic Continuity
• Congenital Abnormalities
• Bicuspid Versus Tricuspid Morphology
• Aortic Stenosis
• Transcatheter Aortic Valve Implantation (TAVI)
• Subaortic Stenosis
• Aortic Regurgitation
• Aortic Valve Endocarditis
• Valve Prostheses
• Take Home Messages

Atria

• Left Atrial Size
• Left Atrial Appendage
• Left Atrial Masses
• Right Atrial Size
• Right Atrial Masses
• Take Home Messages

Right Ventricle

• Right Ventricle
• Assessment of Size and Function
• Quantitation
• Longitudinal Versus Global Right Ventricular Function
• 3D Shape
• Regional Function
• Volume Overload
• Catheters and leads
• Take Home Messages

Tricuspid Valve

• Tricuspid Valve
• Tricuspid Regurgitation
• Primary Tricuspid Regurgitation
• Secondary Tricuspid Regurgitation
• Tricuspid Annulus
• Tricuspid Regurgitation due to Pace-Maker Interference
• Traumatic Tricuspid Regurgitation
• Grading the Severity of Tricuspid Regurgitation
• Tricuspid Stenosis
• Tricuspid Endocarditis
• Ebstein’s Anomaly
• Take Home Messages

Pulmonary Valve

• Normal Pulmonary Valve
• Pulmonary Valve Endocarditis

Aorta

• Normal Aortic Root
• Aortic Atheromas
• Chronic aortic dissection

Congenital heart diseases

• Patent Foramen Ovale
• Ostium Secundum Atrial Septal Defect
• Ostium Primum Atrial Septal Defect
• Sinus Venosus Atrial Septal Defect
• Ventricular Septal Defect
• Patent Ductus Arteriosus
• Double-Inlet Ventricle
• Anomalous Origin of Coronary Arteries
• Congenital Coronary Artery Aneurysm
• Take Home Messages

Unusual Clinical Cases

• Mechanical Complications of Acute Myocardial Infarction
• Multiple Intracardiac Sewing Needles