Real–time Three Dimensional Echocardiography

Real-Time 3D Echocardiographic Quantification of Left Atrial Volume: Multicenter Study for Validation With CMR. 

Mor-Avi V, Yodwut C, Jenkins C, Kühl H, Nesser HJ, Marwick TH, Franke A, Weinert L, Niel J, Steringer-Mascherbauer R, Freed BH, Sugeng L, Lang RM. 

Comment: Increased left atrial volume( LAV) is associated with adverse cardiovascular outcomes. Although LAV measurements are routinely performed using 2DE, this methodology is limited because it is view dependent and relies on geometric assumptions regarding left atrial shape. Real-time 3DE is free of these limitations and accordingly is an attractive alternative for the evaluation of LAV. The present study showed that compared with CMR reference, 3DE-derived LAV measurements are more accurate than 2DE-based analysis, resulting in fewer patients with undetected atrial enlargement.

Reference: JACC Cardiovasc Imaging. 2012 Aug;5(8):769-77.

Anatomy of pulmonary veins by real-time 3D TEE: implications for catheter-based pulmonary vein ablation. 

Faletra FF, Nucifora G, Regoli F, Ho SY, Moccetti T, Auricchio A. 

Comment: Nicely illustrated review regarding the role of 3D echo in catheter based ablation.

Reference: JACC Cardiovasc Imaging. 2012 Apr;5(4):456-62

Novel echocardiographic techniques to assess left atrial size, anatomy and function. 

Cameli M, Lisi M, Righini FM, Mondillo S. 

Comment: This review describes the fundamental concepts of LA 3DE and STE, illustrates how to obtain respective measurements and discuss their recognized and emerging clinical applications.

Reference: Cardiovasc Ultrasound. 2012 Feb 1;10:4.

Left atrial volume by real-time three-dimensional echocardiography: validation by 64-slice multidetector computed tomography 

Miyasaka Y, Tsujimoto S, Maeba H, Yuasa F, Takehana K, Dote K  

Comment: LA volume assessment by three-dimensional echocardiography was correlated closely with that measured by MDCT,  Three-dimensional echocardiography is a feasible noninvasive method to evaluate LA volume.

Reference: J Am Soc Echocardiogr 2011;24:680-686

Imaging the atrial septum using real-time three-dimensional transesophageal echocardiography: technical tips, normal anatomy, and its role in transseptal puncture.  Faletra FF, Nucifora G, Ho SY 

Comment: Demonstration 3D planes and  their consistency with actual anatomy, several RT 3D transesophageal echocardiographic images are matched to equivalent anatomic specimens.

Reference: J Am Soc Echocardiogr 2011;24:593-99

Real-time, fluoroless, anatomic-guided catheter navigation by 3D TEE during ablation procedures 

Faletra FF, Regoli F, Nucifora G, Auricchio A. 

Comment: This paper underlines the role of RT3DE in 4 different ablations procedures.

Reference: JACC Cardiovasc Imaging 2011;4:203-6

Anatomy of right atrial structures by real-time 3D transesophageal echocardiography. 

Faletra FF, Ho SY, Auricchio A.  

Comment: This review describes a step-by-step approach for acquisition and processing of RT 3D TEE images of right atrial structures of relevance to electrophysiologists. For anatomical correlations of RT 3D TEE images, selected images of right atrial structures were matched to anatomical specimens.

Reference: JACC Cardiovasc Imaging 2010;3:966-75.

3D echocardiography of the atrial septum: anatomical features and landmarks for the echocardiographer. 

Pushparajah K, Miller OI, Simpson JM.  

Comment: 3D echocardiography allows demonstration of living anatomy with moving images from novel projections not seen with standard 2-dimensional imaging. In this series, the whole septum can be presented in 1 image, where the anatomic relationships are self-evident.

Reference: JACC Cardiovasc Imaging 2010;3:981-84

Use of real time three-dimensional transesophageal echocardiography in intracardiac catheter based interventions 

Perk G, Lang RM, Garcia-Fernandez MA, Lodato J, Sugeng L, Lopez J, Knight BP, Messika-Zeitoun D, Shah S, Slater J, Brochet E, Varkey M, Hijazi Z, Marino N, Ruiz C, Kronzon I. 

Comment: In this review, the authors describe their experience with this technique, the added value over multiplanar two-dimensional TEE, and the pitfalls that were encountered. The main advantages found for the use RT3D TEE during catheter-based interventions were the ability to visualize the entire lengths of intracardiac catheters, including the tips of all catheters and the balloons or devices they carry, along with a clear depiction of their positions in relation to other cardiac structures, and the ability to ability to demonstrate certain structures in an "en face" view, which is not offered by any other currently available real-time imaging technique, enabling appreciation of the exact nature of the lesion that is undergoing intervention.

Reference: J Am Soc Echocardiogr. 2009 Aug;22(8):865-82

Normal reference ranges for left and right atrial volume indexes and ejection fractions obtained with real-time three-dimensional echocardiography. 

Aune E, Baekkevar M, Roislien J, Rodevand O, Otterstad JE. 

Comment: The present study provides normal ranges for atrial dimensions and contractility with a new, fast, and reproducible technique that can be used bedside without offline analysis.

Reference: Eur J Echocardiogr. 2009 Aug;10(6):738-44. Epub 2009 May 12

Left atrial volume measurement with automated border detection by 3-dimensional echocardiography: comparison with Magnetic Resonance Imaging. 

Artang R, Migrino RQ, Harmann L, Bowers M, Woods TD. 

Comment: Three-dimensional echocardiography with semiautomatic border detection is a practical alternative for obtaining the left atrial volume in a time-efficient manner compared to the current standard. A comparison with cardiac magnetic resonance.

Reference: Cardiovasc Ultrasound. 2009 Mar 31;7:16.

Left Ventricle

 

Quantification of left ventricular volume and global function using a fast automated segmentation tool: validation in a clinical setting.  B

arbosa D, Heyde B, Dietenbeck T, Houle H, Friboulet D, Bernard O, D'hooge J. 

Comment: Real-time 3D echocardiography (RT3DE) has already been shown to be an accurate tool for left ventricular (LV) volume assessment. However, LV border detection in RT3DE remains a time-consuming task jeopardizing the application of this modality in routine practice. We have recently developed a 3D automated segmentation framework (BEAS) able to capture the LV morphology in real-time.BEAS allows for a fast and accurate quantification of 3D cardiac volumes and global function with minimal user input. It may therefore contribute to the integration of 3D echocardiography in routine clinical practice.

Reference: Int J Cardiovasc Imaging. 2012 Aug 1. [Epub ahead of print]

Quantification of Left Ventricular Size and Function Using Contrast-Enhanced Real-Time 3D Imaging with Power Modulation: Comparison with Cardiac MRI. 

Coon PD, Pollard H, Furlong K, Lang RM, Mor-Avi V. 

Comment: In patients with optimal images, real-time 3-D echocardiography (RT3DE) allows accurate evaluation of left ventricular (LV) volumes and ejection fraction (EF). However, in patients with poor acoustic windows, lower correlations were reported. Power modulation (PM) RT3DE imaging that uses low mechanical indices and provides uniform LV opacification could overcome this problem. CE PM RT3DE imaging improved the accuracy of EDV, ESV and EF measurements in patients with poor acoustic windows without significantly affecting those in patients with optimal images. In addition, CE PM RT3DE imaging improved the reproducibility of the measurements, as reflected by a twofold decrease in intermeasurement variability. Importantly, the variability in CE PM RT3DE-derived volumes and EF was under 10%, irrespective of image quality. Reference: Ultrasound Med Biol. 2012 Nov;38(11):1853-1858

Meta-analysis of accuracy of left ventricular mass measurement by three-dimensional echocardiography. 

Shimada YJ, Shiota T. 

Comment: This meta-analysis elucidates the underestimation of LV mass by 3DE, its improvement over the past decade, and factors affecting the bias. These data provide a more detailed basis for improving the accuracy of 3DE, an indispensable step toward further clinical application. Reference: Am J Cardiol. 2012 Aug 1;110(3):445-52

Noninvasive estimation of left ventricular compliance using three-dimensional echocardiography. 

Gayat E, Mor-Avi V, Weinert L, Shah SJ, Yodwut C, Lang RM. 

Comment: Left ventricular (LV) compliance is an important determinant of LV function and can be affected by a variety of cardiovascular conditions. In particular, diastolic dysfunction is associated with altered LV compliance. The end-diastolic pressure-volume relationship (EDPVR) allows a direct, accurate evaluation of LV compliance. This study demonstrates the feasibility of noninvasive estimation of the LV EDPVR and its ability to differentiate normal from abnormal LV compliance using three-dimensional echocardiography.

Reference: J Am Soc Echocardiogr. 2012 Jun;25(6):661-6. Epub 2012 Apr 1.

Feasibility, accuracy, and reproducibility of real-time full-volume 3D transthoracic echocardiography to measure LV volumes and systolic function: a fully automated endocardial contouring algorithm in sinus rhythm and atrial fibrillation. 

Thavendiranathan P, Liu S, Verhaert D, Calleja A, Nitinunu A, Van Houten T, De Michelis N, Simonetti O, Rajagopalan S, Ryan T, Vannan MA 

Comment: Rapid, accurate, and reproducible EF can be obtained by RT-VTTE in NSR and AF patients by using an automated trabecular edge contouring algorithm. Furthermore, automated contour correction to detect the compacted myocardium yields accurate and reproducible 3D LV volumes.

Reference: JACC Cardiovasc Imaging. 2012 Mar;5(3):239-51.

A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography.  Kleijn SA, Aly MF, Knol DL, Terwee CB, Jansma EP, Abd El-Hady YA, Kandil HI, Sorour KA, van Rossum AC, Kamp O. 

Comment: 3DE is a feasible and reliable tool for assessment of LV dyssynchrony and may have additional value to current selection criteria for accurate prediction of response to CRT.

Reference: Eur Heart J Cardiovasc Imaging. 2012 Sep;13(9):763-75

Use of three-dimensional speckle tracking to assess left ventricular myocardial function: intervendor consistency and reproducibility of strain measurements 

Badano LP, Cucchini U, Muraru D, Al Nono O, Sarais C, Iliceto S.  

Reference: Eur Heart J Cardiovasc Imaging (2012)

A meta-analysis and investigation for the source of bias of left ventricular volumes and function by three-dimensional echocardiography in comparison with magnetic resonance imaging. 

Shimada YJ, Shiota T.  

Comment: These data provide a more detailed basis for analyzing and improving the accuracy of 3DE, an indispensable step toward further clinical application in LV assessment.

Reference: Am J Cardiol 2011;107:126-38.

Direct measurement of left ventricular outflow tract area using three-dimensional echocardiography in biplane mode improves accuracy of stroke volume assessment. 

Shahgaldi K, Manouras A, Brodin LA, Winter R.  

Comment: SV and CO calculations using direct measurement of LVOT area is a feasible, accurate and reproducible method and correlates extremely well with 3DE volume measurements. SV and CO calculation by LVOT(A) is therefore an appealing method for LVSV assessment in clinical routine.

Reference: Echocardiography 2010;27:1078-85

Validation of a novel automated border-detection algorithm for rapid and accurate quantitation of left ventricular volumes based on three-dimensional echocardiography. 

Muraru D, Badano LP, Piccoli G, Gianfagna P, Del Mestre L, Ermacora D  

Comment: Comparison of new algorythm for LV automatic detection with CMR.

Reference: Eur J Echocardiogr 2010;11:359-68

Overestimation of Left Ventricular Mass and Misclassification of Ventricular Geometry in Heart Failure Patients by Two-Dimensional Echocardiography in Comparison with Three-Dimensional Echocardiography 

Abramov D, Helmke S, Rumbarger LE, King DL, Maurer MS 

Comment: This study compares the assessment of ventricular size and geometry by 2D and 3D echocardiography in normotensive controls and among HF patients with a normal and a reduced ejection fraction. 2DE overestimates ventricular mass when compared to 3DE among patients with heart failure with both normal and low ejection fractions and leads to significant misclassification of ventricular geometry in many heart failure patients.

Reference: Echocardiography. 2010 Jan 13.

Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging. 

Jenkins C, Moir S, Chan J, Rakhit D, Haluska B, Marwick TH 

Comment: Both contrast enhanced (CE) two-dimensional echocardiography (2DE) and three-dimensional echocardiography (3DE) have been proposed as techniques to improve the accuracy of left ventricular (LV) volume measurements. The present study examines the accuracy of non-contrast (NC) and CE-2DE and 3DE for calculation of LV volumes and ejection fraction (EF), relative to cardiac magnetic resonance imaging (MRI) and shows that CE-2DE is analogous to NC-3DE in accurate categorization of LV function. However, CE-3DE is feasible and superior to other NC- and CE-techniques in patients with previous infarction.

Reference: Eur Heart J. 2009 Jan;30(1):98-106

Comparison of contrast enhanced three dimensional echocardiography with MIBI gated SPECT for the evaluation of left ventricular function.  Cosyns B, Haberman D, Droogmans S, Warzée S, Mahieu P, Laurent E, Moonen M, Hernot S, Lancellotti P. 

Comment: In clinical practice and in clinical trials, echocardiography and scintigraphy are used the most for the evaluation of global left ejection fraction (LVEF) and left ventricular (LV) volumes. Actually, poor quality imaging and geometrical assumptions are the main limitations of LVEF measured by echocardiography. Contrast RT3DE allows an accurate assessment of LVEF compared to the LVEF measured by SPECT, and shows low variability between observers. Although RT3DE triplane provides accurate evaluation of left ventricular function, RT3DE full-volume is superior to triplane modality in patients with suspected coronary artery disease.

Reference: Cardiovasc Ultrasound. 2009 Jun 16;7:27

Feasibility and clinical decision making with 3D echocardiography in routine practice 

Hare JL, Jenkins C, Nakatani S, Ogawa A, Yu CM, Marwick TH. 

Comment: This is the first outcome study using 3D echo. It shows that routine assessment of left ventricular ejection fraction and volumes has significant potential to improve clinical decision-making  when added to a standard and clinically indicated 2D echocardiogram. This was particularly true in patients with LV ejection fraction between 26% and 45%, in whom many decisions about pharmacological treatment or device implantation has to be taken on LV ejection fraction measurement.

Reference: Heart 2008; 94:440-5

Role of real time 3D echocardiography in evaluating the left ventricle 

Monaghan MJ. 

Comment: The unique clinical value of 3D echocardiography in evaluating geometry and function of the left ventricle and how this new technique can overcome the limitations of M-mode and 2D echocardiography are discussed in this review.

Reference: Heart. 2006 Jan;92(1):131-6.

 

Mitral Valve

Three-dimensional echocardiographic analysis of mitral annular dynamics: implication for annuloplasty selection. 

Levack MM, Jassar AS, Shang EK, Vergnat M, Woo YJ, Acker MA, Jackson BM, Gorman JH 3rd, Gorman RC. 

Comment: Small 3D TEE study showing that In both ischemic mitral regurgitation and myxomatous mitral regurgitation, annular dynamics and anatomy are abnormal. Flexible annuloplasty devices used in mitral valve repair are, therefore, unlikely to result in either normal annular dynamics or normal anatomy.

Reference: Circulation. 2012 Sep 11;126(11 Suppl 1):S183-8

Quantitative Real-Time Three-Dimensional Echocardiography Provides New Insight into the Mechanisms of Mitral Valve Regurgitation Post-Repair of Atrioventricular Septal Defect. 

Takahashi K, Mackie AS, Thompson R, Al-Naami G, Inage A, Rebeyka IM, Ross DB, Khoo NS, Colen T, Smallhorn JF. 

Comment: In patients with atrioventricular septal defects, significant mitral valve regurgitation is associated with leaflet prolapse, larger annular area, and lateral papillary muscle displacement as demonstrated by 3D echo.

Reference: J Am Soc Echocardiogr. 2012 Sep 27

Evidence of a vicious cycle in mitral regurgitation with prolapse: secondary tethering attributed to primary prolapse demonstrated by three-dimensional echocardiography exacerbates regurgitation. 

Otani K, Takeuchi M, Kaku K, Haruki N, Yoshitani H, Eto M, Tamura M, Okazaki M, Abe H, Fujino Y, Nishimura Y, Levine RA, Otsuji Y. 

Comment: This 3D TEE study suggests that primary mitral valve prolapse with MR causes secondary mitral leaflet tethering with PM displacement by left ventricular dilatation, which further exacerbates valve leakage, constituting a vicious cycle that would suggest a pathophysiologic rationale for early surgical repair.

Reference: Circulation. 2012 Sep 11;126(11 Suppl 1):S214-21.

Direct measurement of proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography in mitral regurgitation: a validation study. 

de Agustín JA, Marcos-Alberca P, Fernandez-Golfin C, Gonçalves A, Feltes G, Nuñez-Gil IJ, Almeria C, Rodrigo JL, Perez de Isla L, Macaya C, Zamorano J. 

Comment: The two-dimensional (2D) proximal isovelocity surface area (PISA) method has some technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat, real-time three-dimensional (3D) color Doppler imaging allows direct measurement of PISA without geometric assumptions. The aim of this study was to validate this novel method in patients with chronic mitral regurgitation (MR).Direct measurement of PISA without geometric assumptions using single-beat, real-time 3D color Doppler echocardiography is feasible in the clinical setting. MR quantification using this methodology is more accurate than the conventional 2D PISA method.

Reference: J Am Soc Echocardiogr. 2012 Aug;25(8):815-23

Assessment of mitral valve complex by three-dimensional echocardiography: therapeutic strategy for functional mitral regurgitation. 

Yoshida K, Obase K. 

Comment: Three dimensional echocardiography plays an essential role to understand the geometry of mitral valve complex and contributes greatly to decision making of the surgical strategy in functional MR and its postoperative assessment.

Reference: J Cardiovasc Ultrasound. 2012 Jun;20(2):69-76. Epub 2012 Jun 25.

Direct measurement of multiple vena contracta areas for assessing the severity of mitral regurgitation using 3D TEE. 

Hyodo E, Iwata S, Tugcu A, Arai K, Shimada K, Muro T, Yoshikawa J, Yoshiyama M, Gillam LD, Hahn RT, Di Tullio MR, Homma S. 

Comment: Two-dimensional and 3D transesophageal echocardiography was performed in 60 patients with multiple functional MR jets. MR severity was assessed quantitatively using the effective regurgitant orifice area derived from 3D left ventricular volume and thermodilution data. Direct measurement of multiple VC areas using 3D transesophageal echocardiography allows for assessing MR severity in patients with multiple jets, particularly for MR degrees greater than mild and in cases of more than 2 jets, for which geometric assumptions may be challenging.

Reference: JACC Cardiovasc Imaging. 2012 Jul;5(7):669-76.

Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair. 

Biaggi P, Jedrzkiewicz S, Gruner C, Meineri M, Karski J, Vegas A, Tanner FC, Rakowski H, Ivanov J, David TE, Woo A 

Comment: Three-dimensional (3D) transesophageal echocardiography (TEE) is more accurate than two-dimensional (2D) TEE in the qualitative assessment of mitral valve (MV) prolapse (MVP).Measurements of MV anatomy on 3D TEE are accurate compared with surgical measurements. Quantitative MV characteristics, as assessed by 3D TEE, determined the complexity of MV repair.

Reference: J Am Soc Echocardiogr. 2012 Jul;25(7):758-65

Influence of chronic tethering of the mitral valve on mitral leaflet size and coaptation in functional mitral regurgitation.  Saito K, Okura H, Watanabe N, Obase K, Tamada T, Koyama T, Hayashida A, Neishi Y, Kawamoto T, Yoshida K. 

Comment: A 3DTEE study examining whether the tethering of the mitral leaflets affects coaptation in patients with functional mitral regurgitation (FMR) and assessing  the interaction between the mitral coaptation and mitral regurgitation severity.

Reference: JACC Cardiovasc Imaging. 2012 Apr;5(4):337-45

A Three-Dimensional Insight into the Complexity of Flow Convergence in Mitral Regurgitation: Adjunctive Benefit of Anatomic Regurgitant Orifice Area  Chandra S, Salgo IS, Sugeng L, Weinert L, Settlemier SH, Mor-Avi V  

Comment: A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area.

Reference: Am J Physiol Heart Circ Physiol 2011 Sep;301(3):H1015-24

Role of real-time three dimensional echocardiography in cardiovascular interventions. 

Tsang W, Lang RM, Kronzon I.  

Comment: This paper describes general views, and then focuses discussion on the contemporary use of RT 3D TOE in percutaneous procedures such as mitral balloon valvuloplasty, mitral valve repair with clips,  left atrial appendage occlusion, atrial and ventricular septal defect closure, aortic valve replacement, and paravalvular leak occlusion.

Reference: Heart 2011;97:850-857

Assessment of mitral valve prolapse by 3D TEE angled views are key. 

Biaggi P, Gruner C, Jedrzkiewicz S, Karski J, Meineri M, Vegas A  

Comment: This paper underlines the need for systematic views when assessing mitral valve prolapse with RT-3D-TEE.

Reference: JACC Cardiovasc Imaging 2011;4:94-97

Comparison of direct planimetry of mitral valve regurgitation orifice area by three-dimensional transesophageal echocardiography to effective regurgitant orifice area obtained by proximal flow convergence method and vena contracta area determined by color 

Altiok E, Hamada S, van Hall S, Hanenberg M, Dohmen G, Almalla M  

Comment: A comparative study between direct measurement of the regurgitant orifice and the ERO measured by Doppler method in mitral valve regurgitation.

Reference: Am J Cardiol 2011;107:452-58

Real-time three-dimensional transesophageal echocardiography assessment of the mitral valve: perioperative advantages and game-changing findings 

Moustafa SE, Chandrasekaran K, Khandheria B, Tajik J, Mookadam F.  

Comment: Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) represents a unique perioperative cardiovascular imaging tool which, without any need for off-line reconstruction, has been shown to be highly valuable for evaluating mitral valve.

Reference: J Heart Valve Dis 2011;20:114-22.

Validation of a new score for the assessment of mitral stenosis using real-time three-dimensional echocardiography.   

Anwar AM, Attia WM, Nosir YF, Soliman OI, Mosad MA, Othman M  

Comment: A new RT3DE score is feasible and highly reproducible for the assessment of MV morphology in patients with MS. It can provide incremental prognostic information in addition to Wilkins's score.

Reference: J Am Soc Echocardiogr 2010;23:13-22

Core review: three-dimensional transesophageal echocardiography is a major advance for intraoperative clinical management of patients undergoing cardiac surgery: a core review 

Vegas A, Meineri M.  

Comment: Intraoperative RT 3D TEE has elevated TEE to a new fascinating and challenging dimension. Spectacular pictures, ease of use, and simplification of challenging diagnoses are combined in a tool that has not yet revealed its full potential.

Reference: Anesth Analg 2010;110:1548-73

A study of functional anatomy of aortic-mitral valve coupling using 3D matrix transesophageal echocardiography 

Veronesi F, Corsi C, Sugeng L, Mor-Avi V, Caiani EG, Weinert L, Lamberti C, Lang RM. 

Comment: A study reporting quantitative 3D assessment of the mitral and aortic valve dynamics from matrix array transesophageal images and describing the mitral-aortic coupling in a beating human heart. This may have impact on patient evaluation for valvular surgical interventions and prosthesis design.

Reference: Circ Cardiovasc Imaging. 2009 Jan;2(1):24-3

Three-dimensional echocardiography for assessment of mitral valve regurgitation.

Sugeng L, Chandra S, Lang RM. 

Comment: This is a review and a critical appraisal regarding the impact of 3DE for imaging mitral regurgitation. Imaging the proximal flow convergence region (PFCR) and measuring the vena contracta area are highly feasible. The shape of the PFCR may vary, being a hemisphere, prolate or oblate hemispheroid, or hemi-ellipsoid, based on these findings; three-dimensional formulas have a stronger correlation, less underestimation and better accuracy than the two-dimensional proximal isovelocity surface area method. Direct measurements of the effective regurgitant orifice are also feasible and serve as an alternative to hemodynamic formulas.

Reference: Curr Opin Cardiol. 2009 Sep;24(5):420-5

Three-dimensional echocardiography for assessment of mitral valve stenosis. 

Zamorano J, de Agustín JA. 

Comment: 3DE is superior to two-dimensional echocardiography and may be routinely used in the quantification of the mitral valve area (MVA) in mitral stenosis. In the coming years, 3DE might replace Gorlin's method as the gold standard for MVA quantification.

Reference: Curr Opin Cardiol. 2009 Sep;24(5):415-9

Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence. 

Kronzon I, Sugeng L, Perk G, Hirsh D, Weinert L, Garcia Fernandez MA, Lang RM.  C

omment: Mitral valve replacement or repair may be complicated by post-operative dehiscence of the valve or annuloplasty ring resulting in clinically significant mitral regurgitation or hemolysis. Diagnosis is generally performed using 2-dimensional transthoracic echocardiography and TEE. Recently, an RT 3D TEE probe has been developed to produce high-quality real-time images. In mitral valve dehiscence, RT 3D TEE provides additional information about the exact anatomic characteristics of the dehiscence that can be used to help in planning the most appropriate corrective intervention.

Reference: J Am Coll Cardiol. 2009 Apr 28;53(17):1543-7.

Framework for systematic characterization of the mitral valve by real-time three-dimensional transesophageal echocardiography  Salcedo EE, Quaife RA, Seres T, Carroll JD. 

Comment: In this review, the authors present a framework for the application of 3D TEE in the evaluation of patients with structural or functional mitral valve disease, outline an examination protocol, and address the advantages and limitations of the current platform for 3D TEE. Real-time 3D TEE has the real potential to become the main imaging tool for the guidance of surgical and interventional procedures on the mitral valve. Reference: J Am Soc Echocardiogr. 2009 Oct;22(10):1087-99

The Role of Imaging in Chronic Degenerative Mitral Regurgitation  O’Gara P, Sugeng L, Lang R, et al. 

Comment: A very useful review about the assessment of degenerative mitral regurgitation. Very important to understand the 3D echo anatomy of the mitral valve.

Reference: J Am Coll Cardiol Img, 2008; 1:221-237

Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse  Pepi M, Tamborini G, Maltagliati A, Galli CA, Sisillo E, Salvi L, Naliato M, Porqueddu M, Parolari A, Zanobini M, Alamanni F 

Comment: 112 consecutive patients with severe mitral regurgitation due to mitral valve prolapse underwent a complete 2D and 3D TTE the day before surgery and a complete 2D and 3D TEE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection. Three-dimensional techniques were feasible in a relatively short time (3D TTE: 7 +/- 4 min; 3D TEE: 8 +/- 3 min), with good (3D TTE 55%; 3D TEE 35%) and optimal (3D TTE 21%; 3D TEE 45%) imaging quality in the majority of cases. Three-dimensional TEE allowed more accurate identification (95.6% accuracy) of all MV lesions in comparison with other techniques. Three-dimensional TTE and 2D TEE had similar accuracies (90% and 87%, respectively), whereas the accuracy of 2D TTE (77%) was significantly lower. Reference: J Am Coll Cardiol. 2006 Dec 19;48(12):2524-30.

The emerging role of three-dimensional echocardiography in mitral valve repair  Ryan LP, Salgo IS, Gorman RC, Gorman JH 3rd. 

Comment: This article reviews the development of 3D echocardiography and presents illustrations of how it may be applied to improving mitral valve repair techniques. It is conceivable in the near future that mitral repair procedures will be designed and customized for each patient preoperatively using data obtained from 3D echo images and computerized virtual surgery techniques. Reference: Semin Thorac Cardiovasc Surg. 2006 Summer;18(2):126-34

Three-dimensional echocardiography in mitral valve disease  Valocik G, Kamp O, Visser CA. 

Comment: Based on the studies using three-dimensional echocardiography the Authors describe the topography of the mitral valve, its nonplanarity as well as dynamics of the mitral annulus. In addition, they review the use of three-dimensional echocardiography to assess different mitral valve disease. Reference: Eur J Echocardiogr. 2005 Dec;6(6):443-54.

Impact of three-dimensional echocardiography in valvular heart disease.  Salehian O, Chan KL. 

Comment: Developments in the field of 3D ultrasound imaging have allowed better qualitative assessment of valvular structures. The addition of color flow Doppler to the 3D imaging has provided improved visualization of regurgitant lesions and holds great promise for improved quantitative assessment of such lesions. However, clinical benefits of 3D echocardiography are yet to be demonstrated in properly conducted clinical trials, which are needed for wider acceptance of this technique. Reference: Curr Opin Cardiol. 2005 Mar;20(2):122-6.

Pulmonary Valve

Feasibility of pulmonary valve imaging using three-dimensional transthoracic echocardiography  Kelly NF, Platts DG, Burstow DJ 

Comment: Live3D is feasible in evaluating PV short-axis morphology and provides incremental value in the TTE examination. Reference: J Am Soc Echocardiogr 2010;23:1076-80

 

Quantification of left ventricular volume and global function using a fast automated segmentation tool: validation in a clinical setting.  Barbosa D, Heyde B, Dietenbeck T, Houle H, Friboulet D, Bernard O, D'hooge J. 

Comment: Real-time 3D echocardiography (RT3DE) has already been shown to be an accurate tool for left ventricular (LV) volume assessment. However, LV border detection in RT3DE remains a time-consuming task jeopardizing the application of this modality in routine practice. We have recently developed a 3D automated segmentation framework (BEAS) able to capture the LV morphology in real-time.BEAS allows for a fast and accurate quantification of 3D cardiac volumes and global function with minimal user input. It may therefore contribute to the integration of 3D echocardiography in routine clinical practice. Reference: Int J Cardiovasc Imaging. 2012 Aug 1. [Epub ahead of print]

Quantification of Left Ventricular Size and Function Using Contrast-Enhanced Real-Time 3D Imaging with Power Modulation: Comparison with Cardiac MRI.  Coon PD, Pollard H, Furlong K, Lang RM, Mor-Avi V. 

Comment: In patients with optimal images, real-time 3-D echocardiography (RT3DE) allows accurate evaluation of left ventricular (LV) volumes and ejection fraction (EF). However, in patients with poor acoustic windows, lower correlations were reported. Power modulation (PM) RT3DE imaging that uses low mechanical indices and provides uniform LV opacification could overcome this problem. CE PM RT3DE imaging improved the accuracy of EDV, ESV and EF measurements in patients with poor acoustic windows without significantly affecting those in patients with optimal images. In addition, CE PM RT3DE imaging improved the reproducibility of the measurements, as reflected by a twofold decrease in intermeasurement variability. Importantly, the variability in CE PM RT3DE-derived volumes and EF was under 10%, irrespective of image quality. Reference: Ultrasound Med Biol. 2012 Nov;38(11):1853-1858

Meta-analysis of accuracy of left ventricular mass measurement by three-dimensional echocardiography.  Shimada YJ, Shiota T. 

Comment: This meta-analysis elucidates the underestimation of LV mass by 3DE, its improvement over the past decade, and factors affecting the bias. These data provide a more detailed basis for improving the accuracy of 3DE, an indispensable step toward further clinical application. Reference: Am J Cardiol. 2012 Aug 1;110(3):445-52

Noninvasive estimation of left ventricular compliance using three-dimensional echocardiography.  Gayat E, Mor-Avi V, Weinert L, Shah SJ, Yodwut C, Lang RM. 

Comment: Left ventricular (LV) compliance is an important determinant of LV function and can be affected by a variety of cardiovascular conditions. In particular, diastolic dysfunction is associated with altered LV compliance. The end-diastolic pressure-volume relationship (EDPVR) allows a direct, accurate evaluation of LV compliance. This study demonstrates the feasibility of noninvasive estimation of the LV EDPVR and its ability to differentiate normal from abnormal LV compliance using three-dimensional echocardiography. Reference: J Am Soc Echocardiogr. 2012 Jun;25(6):661-6. Epub 2012 Apr 1.

Feasibility, accuracy, and reproducibility of real-time full-volume 3D transthoracic echocardiography to measure LV volumes and systolic function: a fully automated endocardial contouring algorithm in sinus rhythm and atrial fibrillation.  Thavendiranathan P, Liu S, Verhaert D, Calleja A, Nitinunu A, Van Houten T, De Michelis N, Simonetti O, Rajagopalan S, Ryan T, Vannan MA 

Comment: Rapid, accurate, and reproducible EF can be obtained by RT-VTTE in NSR and AF patients by using an automated trabecular edge contouring algorithm. Furthermore, automated contour correction to detect the compacted myocardium yields accurate and reproducible 3D LV volumes. Reference: JACC Cardiovasc Imaging. 2012 Mar;5(3):239-51.

A meta-analysis of left ventricular dyssynchrony assessment and prediction of response to cardiac resynchronization therapy by three-dimensional echocardiography.  Kleijn SA, Aly MF, Knol DL, Terwee CB, Jansma EP, Abd El-Hady YA, Kandil HI, Sorour KA, van Rossum AC, Kamp O. 

Comment: 3DE is a feasible and reliable tool for assessment of LV dyssynchrony and may have additional value to current selection criteria for accurate prediction of response to CRT. Reference: Eur Heart J Cardiovasc Imaging. 2012 Sep;13(9):763-75

Use of three-dimensional speckle tracking to assess left ventricular myocardial function: intervendor consistency and reproducibility of strain measurements  Badano LP, Cucchini U, Muraru D, Al Nono O, Sarais C, Iliceto S.  

Reference: Eur Heart J Cardiovasc Imaging (2012)

A meta-analysis and investigation for the source of bias of left ventricular volumes and function by three-dimensional echocardiography in comparison with magnetic resonance imaging.  Shimada YJ, Shiota T.  

Comment: These data provide a more detailed basis for analyzing and improving the accuracy of 3DE, an indispensable step toward further clinical application in LV assessment. Reference: Am J Cardiol 2011;107:126-38.

Direct measurement of left ventricular outflow tract area using three-dimensional echocardiography in biplane mode improves accuracy of stroke volume assessment.  Shahgaldi K, Manouras A, Brodin LA, Winter R.  

Comment: SV and CO calculations using direct measurement of LVOT area is a feasible, accurate and reproducible method and correlates extremely well with 3DE volume measurements. SV and CO calculation by LVOT(A) is therefore an appealing method for LVSV assessment in clinical routine. Reference: Echocardiography 2010;27:1078-85

Validation of a novel automated border-detection algorithm for rapid and accurate quantitation of left ventricular volumes based on three-dimensional echocardiography.  Muraru D, Badano LP, Piccoli G, Gianfagna P, Del Mestre L, Ermacora D  

Comment: Comparison of new algorythm for LV automatic detection with CMR. Reference: Eur J Echocardiogr 2010;11:359-68

Overestimation of Left Ventricular Mass and Misclassification of Ventricular Geometry in Heart Failure Patients by Two-Dimensional Echocardiography in Comparison with Three-Dimensional Echocardiography  Abramov D, Helmke S, Rumbarger LE, King DL, Maurer MS 

Comment: This study compares the assessment of ventricular size and geometry by 2D and 3D echocardiography in normotensive controls and among HF patients with a normal and a reduced ejection fraction. 2DE overestimates ventricular mass when compared to 3DE among patients with heart failure with both normal and low ejection fractions and leads to significant misclassification of ventricular geometry in many heart failure patients. Reference: Echocardiography. 2010 Jan 13.

Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging.  Jenkins C, Moir S, Chan J, Rakhit D, Haluska B, Marwick TH 

Comment: Both contrast enhanced (CE) two-dimensional echocardiography (2DE) and three-dimensional echocardiography (3DE) have been proposed as techniques to improve the accuracy of left ventricular (LV) volume measurements. The present study examines the accuracy of non-contrast (NC) and CE-2DE and 3DE for calculation of LV volumes and ejection fraction (EF), relative to cardiac magnetic resonance imaging (MRI) and shows that CE-2DE is analogous to NC-3DE in accurate categorization of LV function. However, CE-3DE is feasible and superior to other NC- and CE-techniques in patients with previous infarction. Reference: Eur Heart J. 2009 Jan;30(1):98-106

Comparison of contrast enhanced three dimensional echocardiography with MIBI gated SPECT for the evaluation of left ventricular function.  Cosyns B, Haberman D, Droogmans S, Warzée S, Mahieu P, Laurent E, Moonen M, Hernot S, Lancellotti P. 

Comment: In clinical practice and in clinical trials, echocardiography and scintigraphy are used the most for the evaluation of global left ejection fraction (LVEF) and left ventricular (LV) volumes. Actually, poor quality imaging and geometrical assumptions are the main limitations of LVEF measured by echocardiography. Contrast RT3DE allows an accurate assessment of LVEF compared to the LVEF measured by SPECT, and shows low variability between observers. Although RT3DE triplane provides accurate evaluation of left ventricular function, RT3DE full-volume is superior to triplane modality in patients with suspected coronary artery disease. Reference: Cardiovasc Ultrasound. 2009 Jun 16;7:27

Feasibility and clinical decision making with 3D echocardiography in routine practice  Hare JL, Jenkins C, Nakatani S, Ogawa A, Yu CM, Marwick TH. 

Comment: This is the first outcome study using 3D echo. It shows that routine assessment of left ventricular ejection fraction and volumes has significant potential to improve clinical decision-making  when added to a standard and clinically indicated 2D echocardiogram. This was particularly true in patients with LV ejection fraction between 26% and 45%, in whom many decisions about pharmacological treatment or device implantation has to be taken on LV ejection fraction measurement. Reference: Heart 2008; 94:440-5

Role of real time 3D echocardiography in evaluating the left ventricle  Monaghan MJ. 

Comment: The unique clinical value of 3D echocardiography in evaluating geometry and function of the left ventricle and how this new technique can overcome the limitations of M-mode and 2D echocardiography are discussed in this review. Reference: Heart. 2006 Jan;92(1):131-6.

 

Mitral Valve

Three-dimensional echocardiographic analysis of mitral annular dynamics: implication for annuloplasty selection.  Levack MM, Jassar AS, Shang EK, Vergnat M, Woo YJ, Acker MA, Jackson BM, Gorman JH 3rd, Gorman RC. 

Comment: Small 3D TEE study showing that In both ischemic mitral regurgitation and myxomatous mitral regurgitation, annular dynamics and anatomy are abnormal. Flexible annuloplasty devices used in mitral valve repair are, therefore, unlikely to result in either normal annular dynamics or normal anatomy. Reference: Circulation. 2012 Sep 11;126(11 Suppl 1):S183-8

Quantitative Real-Time Three-Dimensional Echocardiography Provides New Insight into the Mechanisms of Mitral Valve Regurgitation Post-Repair of Atrioventricular Septal Defect.  Takahashi K, Mackie AS, Thompson R, Al-Naami G, Inage A, Rebeyka IM, Ross DB, Khoo NS, Colen T, Smallhorn JF. 

Comment: In patients with atrioventricular septal defects, significant mitral valve regurgitation is associated with leaflet prolapse, larger annular area, and lateral papillary muscle displacement as demonstrated by 3D echo. Reference: J Am Soc Echocardiogr. 2012 Sep 27

Evidence of a vicious cycle in mitral regurgitation with prolapse: secondary tethering attributed to primary prolapse demonstrated by three-dimensional echocardiography exacerbates regurgitation.  Otani K, Takeuchi M, Kaku K, Haruki N, Yoshitani H, Eto M, Tamura M, Okazaki M, Abe H, Fujino Y, Nishimura Y, Levine RA, Otsuji Y. 

Comment: This 3D TEE study suggests that primary mitral valve prolapse with MR causes secondary mitral leaflet tethering with PM displacement by left ventricular dilatation, which further exacerbates valve leakage, constituting a vicious cycle that would suggest a pathophysiologic rationale for early surgical repair. Reference: Circulation. 2012 Sep 11;126(11 Suppl 1):S214-21.

Direct measurement of proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography in mitral regurgitation: a validation study.  de Agustín JA, Marcos-Alberca P, Fernandez-Golfin C, Gonçalves A, Feltes G, Nuñez-Gil IJ, Almeria C, Rodrigo JL, Perez de Isla L, Macaya C, Zamorano J. 

Comment: The two-dimensional (2D) proximal isovelocity surface area (PISA) method has some technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat, real-time three-dimensional (3D) color Doppler imaging allows direct measurement of PISA without geometric assumptions. The aim of this study was to validate this novel method in patients with chronic mitral regurgitation (MR).Direct measurement of PISA without geometric assumptions using single-beat, real-time 3D color Doppler echocardiography is feasible in the clinical setting. MR quantification using this methodology is more accurate than the conventional 2D PISA method. Reference: J Am Soc Echocardiogr. 2012 Aug;25(8):815-23

Assessment of mitral valve complex by three-dimensional echocardiography: therapeutic strategy for functional mitral regurgitation.  Yoshida K, Obase K. 

Comment: Three dimensional echocardiography plays an essential role to understand the geometry of mitral valve complex and contributes greatly to decision making of the surgical strategy in functional MR and its postoperative assessment. Reference: J Cardiovasc Ultrasound. 2012 Jun;20(2):69-76. Epub 2012 Jun 25.

Direct measurement of multiple vena contracta areas for assessing the severity of mitral regurgitation using 3D TEE.  Hyodo E, Iwata S, Tugcu A, Arai K, Shimada K, Muro T, Yoshikawa J, Yoshiyama M, Gillam LD, Hahn RT, Di Tullio MR, Homma S. 

Comment: Two-dimensional and 3D transesophageal echocardiography was performed in 60 patients with multiple functional MR jets. MR severity was assessed quantitatively using the effective regurgitant orifice area derived from 3D left ventricular volume and thermodilution data. Direct measurement of multiple VC areas using 3D transesophageal echocardiography allows for assessing MR severity in patients with multiple jets, particularly for MR degrees greater than mild and in cases of more than 2 jets, for which geometric assumptions may be challenging. Reference: JACC Cardiovasc Imaging. 2012 Jul;5(7):669-76.

Quantification of mitral valve anatomy by three-dimensional transesophageal echocardiography in mitral valve prolapse predicts surgical anatomy and the complexity of mitral valve repair.  Biaggi P, Jedrzkiewicz S, Gruner C, Meineri M, Karski J, Vegas A, Tanner FC, Rakowski H, Ivanov J, David TE, Woo A 

Comment: Three-dimensional (3D) transesophageal echocardiography (TEE) is more accurate than two-dimensional (2D) TEE in the qualitative assessment of mitral valve (MV) prolapse (MVP).Measurements of MV anatomy on 3D TEE are accurate compared with surgical measurements. Quantitative MV characteristics, as assessed by 3D TEE, determined the complexity of MV repair. Reference: J Am Soc Echocardiogr. 2012 Jul;25(7):758-65

Influence of chronic tethering of the mitral valve on mitral leaflet size and coaptation in functional mitral regurgitation.  Saito K, Okura H, Watanabe N, Obase K, Tamada T, Koyama T, Hayashida A, Neishi Y, Kawamoto T, Yoshida K. 

Comment: A 3DTEE study examining whether the tethering of the mitral leaflets affects coaptation in patients with functional mitral regurgitation (FMR) and assessing  the interaction between the mitral coaptation and mitral regurgitation severity. Reference: JACC Cardiovasc Imaging. 2012 Apr;5(4):337-45

A Three-Dimensional Insight into the Complexity of Flow Convergence in Mitral Regurgitation: Adjunctive Benefit of Anatomic Regurgitant Orifice Area  Chandra S, Salgo IS, Sugeng L, Weinert L, Settlemier SH, Mor-Avi V  

Comment: A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area. Reference: Am J Physiol Heart Circ Physiol 2011 Sep;301(3):H1015-24

Role of real-time three dimensional echocardiography in cardiovascular interventions.  Tsang W, Lang RM, Kronzon I.  

Comment: This paper describes general views, and then focuses discussion on the contemporary use of RT 3D TOE in percutaneous procedures such as mitral balloon valvuloplasty, mitral valve repair with clips,  left atrial appendage occlusion, atrial and ventricular septal defect closure, aortic valve replacement, and paravalvular leak occlusion. Reference: Heart 2011;97:850-857

Assessment of mitral valve prolapse by 3D TEE angled views are key.  Biaggi P, Gruner C, Jedrzkiewicz S, Karski J, Meineri M, Vegas A  

Comment: This paper underlines the need for systematic views when assessing mitral valve prolapse with RT-3D-TEE. Reference: JACC Cardiovasc Imaging 2011;4:94-97

Comparison of direct planimetry of mitral valve regurgitation orifice area by three-dimensional transesophageal echocardiography to effective regurgitant orifice area obtained by proximal flow convergence method and vena contracta area determined by color  Altiok E, Hamada S, van Hall S, Hanenberg M, Dohmen G, Almalla M  

Comment: A comparative study between direct measurement of the regurgitant orifice and the ERO measured by Doppler method in mitral valve regurgitation. Reference: Am J Cardiol 2011;107:452-58

Real-time three-dimensional transesophageal echocardiography assessment of the mitral valve: perioperative advantages and game-changing findings  Moustafa SE, Chandrasekaran K, Khandheria B, Tajik J, Mookadam F.  

Comment: Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) represents a unique perioperative cardiovascular imaging tool which, without any need for off-line reconstruction, has been shown to be highly valuable for evaluating mitral valve. Reference: J Heart Valve Dis 2011;20:114-22.

Validation of a new score for the assessment of mitral stenosis using real-time three-dimensional echocardiography.   Anwar AM, Attia WM, Nosir YF, Soliman OI, Mosad MA, Othman M  

Comment: A new RT3DE score is feasible and highly reproducible for the assessment of MV morphology in patients with MS. It can provide incremental prognostic information in addition to Wilkins's score. Reference: J Am Soc Echocardiogr 2010;23:13-22

Core review: three-dimensional transesophageal echocardiography is a major advance for intraoperative clinical management of patients undergoing cardiac surgery: a core review  Vegas A, Meineri M.  

Comment: Intraoperative RT 3D TEE has elevated TEE to a new fascinating and challenging dimension. Spectacular pictures, ease of use, and simplification of challenging diagnoses are combined in a tool that has not yet revealed its full potential. Reference: Anesth Analg 2010;110:1548-73

A study of functional anatomy of aortic-mitral valve coupling using 3D matrix transesophageal echocardiography  Veronesi F, Corsi C, Sugeng L, Mor-Avi V, Caiani EG, Weinert L, Lamberti C, Lang RM. 

Comment: A study reporting quantitative 3D assessment of the mitral and aortic valve dynamics from matrix array transesophageal images and describing the mitral-aortic coupling in a beating human heart. This may have impact on patient evaluation for valvular surgical interventions and prosthesis design. Reference: Circ Cardiovasc Imaging. 2009 Jan;2(1):24-3

Three-dimensional echocardiography for assessment of mitral valve regurgitation.  Sugeng L, Chandra S, Lang RM.  Comment: This is a review and a critical appraisal regarding the impact of 3DE for imaging mitral regurgitation. Imaging the proximal flow convergence region (PFCR) and measuring the vena contracta area are highly feasible. The shape of the PFCR may vary, being a hemisphere, prolate or oblate hemispheroid, or hemi-ellipsoid, based on these findings; three-dimensional formulas have a stronger correlation, less underestimation and better accuracy than the two-dimensional proximal isovelocity surface area method. Direct measurements of the effective regurgitant orifice are also feasible and serve as an alternative to hemodynamic formulas. Reference: Curr Opin Cardiol. 2009 Sep;24(5):420-5

Three-dimensional echocardiography for assessment of mitral valve stenosis.  Zamorano J, de Agustín JA. 

Comment: 3DE is superior to two-dimensional echocardiography and may be routinely used in the quantification of the mitral valve area (MVA) in mitral stenosis. In the coming years, 3DE might replace Gorlin's method as the gold standard for MVA quantification. Reference: Curr Opin Cardiol. 2009 Sep;24(5):415-9

Real-time 3-dimensional transesophageal echocardiography in the evaluation of post-operative mitral annuloplasty ring and prosthetic valve dehiscence.  Kronzon I, Sugeng L, Perk G, Hirsh D, Weinert L, Garcia Fernandez MA, Lang RM. 

Comment: Mitral valve replacement or repair may be complicated by post-operative dehiscence of the valve or annuloplasty ring resulting in clinically significant mitral regurgitation or hemolysis. Diagnosis is generally performed using 2-dimensional transthoracic echocardiography and TEE. Recently, an RT 3D TEE probe has been developed to produce high-quality real-time images. In mitral valve dehiscence, RT 3D TEE provides additional information about the exact anatomic characteristics of the dehiscence that can be used to help in planning the most appropriate corrective intervention. Reference: J Am Coll Cardiol. 2009 Apr 28;53(17):1543-7.

Framework for systematic characterization of the mitral valve by real-time three-dimensional transesophageal echocardiography  Salcedo EE, Quaife RA, Seres T, Carroll JD. 

Comment: In this review, the authors present a framework for the application of 3D TEE in the evaluation of patients with structural or functional mitral valve disease, outline an examination protocol, and address the advantages and limitations of the current platform for 3D TEE. Real-time 3D TEE has the real potential to become the main imaging tool for the guidance of surgical and interventional procedures on the mitral valve. Reference: J Am Soc Echocardiogr. 2009 Oct;22(10):1087-99

The Role of Imaging in Chronic Degenerative Mitral Regurgitation  O’Gara P, Sugeng L, Lang R, et al. 

Comment: A very useful review about the assessment of degenerative mitral regurgitation. Very important to understand the 3D echo anatomy of the mitral valve. Reference: J Am Coll Cardiol Img, 2008; 1:221-237

Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse  Pepi M, Tamborini G, Maltagliati A, Galli CA, Sisillo E, Salvi L, Naliato M, Porqueddu M, Parolari A, Zanobini M, Alamanni F 

Comment: 112 consecutive patients with severe mitral regurgitation due to mitral valve prolapse underwent a complete 2D and 3D TTE the day before surgery and a complete 2D and 3D TEE in the operating room. Echocardiographic data obtained by the different techniques were compared with surgical inspection. Three-dimensional techniques were feasible in a relatively short time (3D TTE: 7 +/- 4 min; 3D TEE: 8 +/- 3 min), with good (3D TTE 55%; 3D TEE 35%) and optimal (3D TTE 21%; 3D TEE 45%) imaging quality in the majority of cases. Three-dimensional TEE allowed more accurate identification (95.6% accuracy) of all MV lesions in comparison with other techniques. Three-dimensional TTE and 2D TEE had similar accuracies (90% and 87%, respectively), whereas the accuracy of 2D TTE (77%) was significantly lower. Reference: J Am Coll Cardiol. 2006 Dec 19;48(12):2524-30.

The emerging role of three-dimensional echocardiography in mitral valve repair  Ryan LP, Salgo IS, Gorman RC, Gorman JH 3rd.  Comment: This article reviews the development of 3D echocardiography and presents illustrations of how it may be applied to improving mitral valve repair techniques. It is conceivable in the near future that mitral repair procedures will be designed and customized for each patient preoperatively using data obtained from 3D echo images and computerized virtual surgery techniques. Reference: Semin Thorac Cardiovasc Surg. 2006 Summer;18(2):126-34

Three-dimensional echocardiography in mitral valve disease  Valocik G, Kamp O, Visser CA. 

Comment: Based on the studies using three-dimensional echocardiography the Authors describe the topography of the mitral valve, its nonplanarity as well as dynamics of the mitral annulus. In addition, they review the use of three-dimensional echocardiography to assess different mitral valve disease. Reference: Eur J Echocardiogr. 2005 Dec;6(6):443-54.

Impact of three-dimensional echocardiography in valvular heart disease.  Salehian O, Chan KL. 

Comment: Developments in the field of 3D ultrasound imaging have allowed better qualitative assessment of valvular structures. The addition of color flow Doppler to the 3D imaging has provided improved visualization of regurgitant lesions and holds great promise for improved quantitative assessment of such lesions. However, clinical benefits of 3D echocardiography are yet to be demonstrated in properly conducted clinical trials, which are needed for wider acceptance of this technique. Reference: Curr Opin Cardiol. 2005 Mar;20(2):122-6.

 Pulmonary Valve

Feasibility of pulmonary valve imaging using three-dimensional transthoracic echocardiography  Kelly NF, Platts DG, Burstow DJ 

Comment: Live3D is feasible in evaluating PV short-axis morphology and provides incremental value in the TTE examination. Reference: J Am Soc Echocardiogr 2010;23:1076-80

 

Recommendation paper

EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography.  Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA  Comment: A review how to acquire analyse display the 3D echo imaging and summary of the main strenghts and weaknesses of the technique. Reference: Eur Heart J Cardiovasc Imaging. 2012 Jan;13(1):1-46

Right Ventricle

Three-dimensional analysis of right ventricular shape and function in pulmonary hypertension.  Leary PJ, Kurtz CE, Hough CL, Waiss MP, Ralph DD, Sheehan FH. 

Comment: Right ventricular (RV) failure is a key determinant of morbidity and mortality in pulmonary hypertension (PH). The present study aims to add to existing descriptions of RV structural and functional changes in PH through a comprehensive three-dimensional (3D) shape analysis.  This work describes increased eccentricity and decreased systolic function in subjects with PH. Functional parameters were associated with NYHA class and heterogeneity in the phenotype was noted between subjects withidiopathic PH  and decreased function compared with connective tissue disease associated PH. Reference: Pulm Circ. 2012 Jan;2(1):34-40.

Evaluation of right ventricular systolic function after mitral valve repair: a two-dimensional Doppler, spe

ckle-tracking, and three-dimensional echocardiographic study.  Maffessanti F, Gripari P, Tamborini G, Muratori M, Fusini L, Alamanni F, Zanobini M, Fiorentini C, Caiani EG, Pepi M. 

Comment: Conventional indices of right ventricular (RV) function are known to be reduced after cardiac surgery, as a consequence of geometric rather than functional alterations. Although 3D ejection fraction was preserved after surgery, in agreement with the lack of evidence of RV dysfunction, two-dimensional indices showed a functional loss in the longitudinal direction. Fractional area change, as a combination of radial and longitudinal properties, was slightly decreased. Speckle-tracking echocardiography could constitute a useful approach to relate local and space-dependent changes to the global RV function. Reference: J Am Soc Echocardiogr. 2012 Jul;25(7):701-8

 

Dynamics of the tricuspid valve annulus in normal and dilated right hearts: a three-dimensional transoesophageal echocardiography study.  Ring L, Rana BS, Kydd A, Boyd J, Parker K, Rusk RA. 

Comment: As the mitral valve, the tricuspid valve should be  better descibed as the tricuspid valve apparatus. Three-dimensional TOE allows us to examine the TVA in great detail. In patients with DRH, the TVA dilates in a SL direction, resulting in a more circular orifice. The dynamic changes of the TVA are lost in patients with DRH, potentially contributing to functional tricuspid regurgitation. Reference: Eur Heart J Cardiovasc Imaging. 2012 Sep;13(9):756-62

 

Right ventricular imaging by two-dimensional and three-dimensional echocardiography.  Mangion JR.  

Comment: The current state of three-dimensional imaging of the right ventricle will be highlighted along with the challenges for making this powerful tool more widespread. Reference: Curr Opin Cardiol 2010;25:423-29..

 

Multimodality Comparison of Quantitative Volumetric Analysis of the Right Ventricle  Sugeng L, Mor-Avi V, Weinert L, Niel J, Ebner C, Steringer-Mascherbauer R, Bartolles R, Baumann R, Schummers G, Lang RM, Nesser HJ. 

Comment: Volumetric quantification of RV volume, was tested on cardiac magnetic resonance (CMR), cardiac computed tomography (CCT), and real time 3D echocardiography (RT3DE) images. This analysis overcomes many of the known hurdles that impeded accurate assessment of this geometrically complex chamber in the past, and can be used with all 3 imaging modalities. However, RV volume measurements are not interchangeable between modalities and, therefore, serial evaluations should preferably be performed using the same modality.

Reference: JACC Cardiovasc Imaging. 2010 Jan;3(1):10-18

 

Normal values of right ventricular size and function by real-time 3-dimensional echocardiography: comparison with cardiac magnetic resonance imaging 

Gopal AS, Chukwu EO, Iwuchukwu CJ, Katz AS, Toole RS, Schapiro W, Reichek N. 

Comment: End-diastolic volume, end-systolic volume, stroke volume, and ejection fraction obtained by 2DECHO, RT3DECHO short-axis disk summation (DS), and RT3DECHO apical rotation were compared with cardiac magnetic resonance imaging in 71 healthy individuals. RT3DECHO DS showed less volume underestimation compared with 2DECHO and RT3DECHO apical rotation. Test-retest variability for RT3DECHO DS end-diastolic volume, end-systolic volume, stroke volume, and ejection fraction were 3.3%, 8.7%, 10%, and 10.3%, respectively. Normal reference ranges of indexed volumes (mean±2SD) for right ventricular end-diastolic volume, end-systolic volume, stroke volume, and ejection fraction were 38.6 to 92.2 mL/m2, 7.8 to 50.6 mL/m2, 22.5 to 42.9 mL/m2, and 38.0% to 65.3%, respectively, for women and 47.0 to 100 mL/m2, 23.0 to 52.6 mL/m2, 14.2 to 48.4 mL/m2, and 29.9% to 58.4%, respectively, for men. Reference: J Am Soc Echocardiogr. 2007 May;20(5):445-55

Stress 3D echo

High volume-rate three-dimensional stress echocardiography to assess inducible myocardial ischemia: a feasibility study 

Badano LP, Muraru D, Rigo F, Del Mestre L, Ermacora D, Gianfagna P  

Comment: Compared with previous three-dimensional (3D) echocardiographic scanners, high-volume rate scanners allow higher temporal resolution and the possibility of displaying cropped images side by side. These new features make 3D echocardiography (3DE) even more attractive for application during stress. Three-dimensional echocardiography with DipSE is feasible and offers shorter acquisition and analysis times compared with 2DE, with similar overall diagnostic accuracy. However, the ability of 3DE to identify wall motion abnormalities in the apical region explains its higher sensitivity for the left anterior descending coronary artery territory.

Reference:

J Am Soc Echocardiogr 2010;23:628-35

Tricuspid Valve    

Evaluation of tricuspid valve morphology and function by transthoracic three-dimensional echocardiography.
Muraru D, Badano LP, Sarais C, Solda E, Iliceto S.
Comment:
This review summarizes the current status of 3DE for the assessment of TV morphology and function, with its clinical applications and current limitations, as well as its potential implications for designing TV repair techniques.
Reference:
Curr Cardiol Rep 2011;13:242-49

Evaluation of the tricuspid valve morphology and function by transthoracic real-time three-dimensional echocardiography
Badano LP, Agricola E, Perez de Isla L, Gianfagna P, Zamorano JL.
Comment:
This review details the current status of real-time three-dimensional echocardiography evaluation of TV morphology and function with its clinical applications and limitations.
Reference:
Eur J Echocardiogr. 2009 Jun;10(4):477-8