Advanced Echocardiographic Imaging of the Congenitally Malformed Heart

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.] 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.

Ultrasound-Derived Three-Dimensional Printing in Congenital Heart Disease

“…Significant advancement in echocardiography has enabled improved visualization of both morphological and functional information in patients with congenital heart disease. The clinical applications of 3D echocardiography (Table 1) has enhanced preoperative decision-making in congenital heart defects as it provides adequate image resolution with the most integrated display of structure, function, and flow [2,5]. Unlike CT and MRI, 3D echocardiography is a bedside tool useful in obtaining adequate quality images in most patients without general anesthesia.…”

“…Three-dimensional echocardiography is another imaging modality with strong linear correlation with CT and cardiac MRI [5,6]. As a bedside tool, it is safe for severely ill patients who do not have to be transported to and positioned in a CT or MRI scanner, and eliminates the need for sedation or general anesthesia [6].…”

Integration of Computed Tomography and Three-Dimensional Echocardiography for Hybrid Three-Dimensional Printing in Congenital Heart Disease

“…In contrast, CMR has superior temporal resolution and provides highly accurate measurements of ventricular volumes and mass as it is more suitable for analyzing moving structures [4,6]. Three-dimensional echocardiography is superior to other imaging modalities in reconstructing the morphology of the valves and for detailed visualization of the sub-valve apparatus [7,8]. Although echocardiography is useful in demonstrating the anatomy of the different phases of the cardiac cycle, CT and CMR offer better blood pool to myocardial contrast [9].…”