Dynamic Three‐Dimensional Echocardiographic Imaging of Congenital Heart Defects in Infants and Children by Computer‐Controlled Tomographic Parallel Slicing Using a Single Integrated Ultrasound Instrument

Abstract

Three-dimensional cardiac reconstruction generated from transesophageal interrogation can be performed using an integrated unit that captures, processes, and postprocesses tomographic parallel slices of the heart. This probe was used for infants and young children in the transthoracic position to evaluate the feasibility of producing three-dimensional cardiac images with capability for real-time dynamic display. Twenty-two infants and children (range 1 day-3.5 years) underwent image acquisition using a 16 mm 5 MHz 64 element probe placed over the precordium. Two infants were also imaged from the subcostal position. Data was obtained and stored over a single cardiac cycle after acceptable cardiac and respiratory gating intervals were met. The transducer was advanced in 0.5-1 mm increments over the cardiac structures using identical acquisition criteria. The images were reconstructed from the stored digital cubic format and could be oriented in any desired plane. In 9 of the 22 infants the images obtained were of optimal quality. The images obtained displayed normal cardiac structures emphasizing depth relationships as well as visualization of planes not generally demonstrated by two-dimensional imaging. Several lesions were also depicted in a unique fashion using this technique. Though the method employed was limited by movement artifact and reconstruction time, the quality of the three-dimensional display was excellent and enhanced by real-time demonstration. The transthoracic approach was successful in capturing sufficient data to create three-dimensional images, which may have further application in more accurate diagnosis of complex cardiac abnormalities and generation of planes of view which could duplicate surgical visualization of a lesion. Further assessment of the technique in infants with congenital heart disease is warranted.

Initial Experience with an Internally Rotating Transthoracic Three‐Dimensional Echocardiographic Probe and Image Acquisition on a Conventional Echocardiogram Machine

“…Poor examination windows can Vol. 15 lead to the production of low quality images and subsequent reconstructions. Examination windows are determined by the physical status (e.g., size and body fat percentage) of the patient and are mostly uncontrollable.…”

Three-dimensional echocardiography: lessons in overcoming time and space

“…The images were directly transferred to a workstation (Echo-View, TomTec Imaging Systems) and digitally converted into a prismatic shaped dataset. This transducer assembly was also utilized precordially in children and good results were reported [19].…”

Three-Dimensional Echo: Transition from Theory to Real-Time, A Technology Now Ready for Prime Time

“…The ability to accurately render anatomical data with linear 3DE has been shown both in vitro 78 and in patients by using both transthoracic and transesophageal approaches with a variety of reference standards such as anatomic specimens and MRI. 75,77,79,80,92 "Surgical" views were obtained using this technique by Vogel and coworkers that assisted planning of operative or nonoperative correction of a variety of defects ranging from atrial and ventricular septal defects to atrioventricular valvular anomalies and left ventricular outflow tract obstruction. 75 Linear sequential 3DE provided clinically useful additional information to available 2DE data in 14 of 77 adult patients with congenital heart disease evaluated by Bartel and coworkers.…”

“…[75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91] The ability of 3DE to provide detailed anatomic views from unconventional perspectives and associate anatomic structures with functional data make the technique particularly appealing for use in this specific subset of patients.…”